Provider Demographics
NPI:1073034732
Name:SHIFFLETT, MICHELLE LYNN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:SHIFFLETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:313 PHILEMA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-7200
Mailing Address - Country:US
Mailing Address - Phone:229-300-6865
Mailing Address - Fax:
Practice Address - Street 1:814 NORTHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1398
Practice Address - Country:US
Practice Address - Phone:229-262-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148517367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife