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General NPI Number Information
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NPI Number | 1629206503
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Entity Type | Individual
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Provider Name | MICHELE SHUMPERT D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 1110 FARR RD SUITE C
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City | COLUMBUS
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State | GA
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Zip | 31907-8628
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Country | US
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Telephone | 706-683-0909
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Fax | 706-683-9757
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Provider Business Mailing Address
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Address Line | PO BOX 1584
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City | FORTSON
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State | GA
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Zip | 31808-1584
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Country | US
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Telephone | 404-910-3697
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Fax | 404-910-3697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 003793
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66322
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License Number State | GA
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