Provider Demographics
NPI:1104888130
Name:CAHILL, MICHELE W (CRNA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:W
Last Name:CAHILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MICHELE
Other - Last Name:WOODS CAHILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:18 MCQUEEN STREET
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316
Mailing Address - Country:US
Mailing Address - Phone:912-369-9400
Mailing Address - Fax:
Practice Address - Street 1:462 ELMA G MILES PKWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4000
Practice Address - Country:US
Practice Address - Phone:912-369-3647
Practice Address - Fax:912-369-3647
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN067957367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000691655EMedicaid
GA000691655GMedicaid
43BBBKZMedicare ID - Type Unspecified
GAP00630645Medicare PIN
GA511I430529Medicare PIN