Provider Demographics
NPI:1073768545
Name:HALL, MICHELLE FOSTER (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FOSTER
Last Name:HALL
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PADDOCK PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9119
Mailing Address - Country:US
Mailing Address - Phone:678-474-9633
Mailing Address - Fax:678-679-5272
Practice Address - Street 1:3380 PADDOCKS PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9119
Practice Address - Country:US
Practice Address - Phone:678-474-9633
Practice Address - Fax:678-474-9752
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157997363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123163AMedicaid
GA003123163CMedicaid