Healthcare Provider Details

I. General information

NPI: 1750887436
Provider Name (Legal Business Name): MICHELLE ANNE GEORGIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

9960 MAYLAND DR STE 300
HENRICO VA
23233-1485
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7874
  • Fax: 757-668-8658
Mailing address:
  • Phone: 800-533-1560
  • Fax: 800-533-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102206716
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0102206716
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: