MEDICARE: MICHELLE MAXWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LDA004431	GA

General Provider Information

NPI Number	:	1801452750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MAXWELL

Provider Business Mailing Address
First Line	:	3660 KILPATRICK CT
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-8622
Country	:	US
Telephone Number	:	786-260-5758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE BLDG A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-4108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	04/12/2026

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Directions to “ MICHELLE MAXWELL ” Practice Location

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