Provider Demographics
NPI:1124466750
Name:ST CLAIR, MICHELLE DENISE (HEALTH CARE PROVIDER)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DENISE
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 PLUMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-9020
Mailing Address - Country:US
Mailing Address - Phone:678-677-1225
Mailing Address - Fax:
Practice Address - Street 1:841 PLUMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-9020
Practice Address - Country:US
Practice Address - Phone:678-677-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0524407202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer