Provider Demographics
NPI:1972742146
Name:ANDERSON, MICHELLE ANNMARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNMARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BLACKTOP DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4442
Mailing Address - Country:US
Mailing Address - Phone:404-421-0542
Mailing Address - Fax:
Practice Address - Street 1:115 BLACKTOP DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4442
Practice Address - Country:US
Practice Address - Phone:770-969-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165519163WC1500X, 163WH0200X, 163WP0809X, 174400000X, 163W00000X, 364S00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide