Healthcare Provider Details

I. General information

NPI: 1770401598
Provider Name (Legal Business Name): MICHELLE FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5244 NEW JOHN HAGAR RD
HERMITAGE TN
37076-5624
US

IV. Provider business mailing address

5244 NEW JOHN HAGAR RD
HERMITAGE TN
37076-5624
US

V. Phone/Fax

Practice location:
  • Phone: 678-548-0265
  • Fax:
Mailing address:
  • Phone: 678-548-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9862
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: