Healthcare Provider Details

I. General information

NPI: 1588423610
Provider Name (Legal Business Name): JONATHAN SCOTT MICHELS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEDICAL PARK LN STE H
MURPHY NC
28906-6921
US

IV. Provider business mailing address

2546 BATAVIA ST
EAST POINT GA
30344-2843
US

V. Phone/Fax

Practice location:
  • Phone: 828-837-3525
  • Fax: 828-837-6923
Mailing address:
  • Phone: 336-596-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14187
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: