Provider Demographics
NPI:1316750540
Name:JEAN MARY, MICHELET
Entity type:Individual
Prefix:
First Name:MICHELET
Middle Name:
Last Name:JEAN MARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 IVY CHASE WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4253
Mailing Address - Country:US
Mailing Address - Phone:943-223-0827
Mailing Address - Fax:
Practice Address - Street 1:7106 IVY CHASE WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4253
Practice Address - Country:US
Practice Address - Phone:943-223-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter