Provider Demographics
NPI:1407832785
Name:CELLAI, MICHELE (DNP)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:CELLAI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON RD NE BLDG A1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-1234
Mailing Address - Fax:404-778-2710
Practice Address - Street 1:1365 CLIFTON RD NE BLDG A1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-1234
Practice Address - Fax:404-778-2710
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263494363L00000X
GARN273572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0799297Medicaid
92778OtherFALLON COMMUNITY HELATH P
0799297OtherMEDICAID/WELFARE