Provider Demographics
NPI:1104974880
Name:MICHEL, DAVID (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4548
Practice Address - Country:US
Practice Address - Phone:770-460-1900
Practice Address - Fax:770-719-1214
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-06-03
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Provider Licenses
StateLicense IDTaxonomies
GA2508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I970747Medicare PIN
GA202I974766Medicare PIN