Provider Demographics
NPI:1124452081
Name:MCDOUGLE, MICHELLE A (MS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:MCDOUGLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5069 AFTON WAY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2670
Mailing Address - Country:US
Mailing Address - Phone:706-537-0729
Mailing Address - Fax:
Practice Address - Street 1:5945 OPTICAL CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1400
Practice Address - Country:US
Practice Address - Phone:678-888-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS