Healthcare Provider Details

I. General information

NPI: 1285633941
Provider Name (Legal Business Name): MICHELLE A CHRISTIAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4692 BROWNSBORO RD PHYSICIANS ELDERCARE
WINSTON SALEM NC
27106-3410
US

IV. Provider business mailing address

4692 BROWNSBORO RD PHYSICIANS ELDERCARE
WINSTON SALEM NC
27106-3410
US

V. Phone/Fax

Practice location:
  • Phone: 336-251-1114
  • Fax: 336-251-1115
Mailing address:
  • Phone: 336-251-1114
  • Fax: 336-251-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101536
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003223
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: