Provider Demographics
NPI:1104852078
Name:DUPONT, MICHELLE LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEE
Last Name:DUPONT
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:845 CINDERELLA CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5811
Mailing Address - Country:US
Mailing Address - Phone:770-474-7416
Mailing Address - Fax:770-389-6210
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:SUITE 304
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4548
Practice Address - Country:US
Practice Address - Phone:678-817-4390
Practice Address - Fax:678-817-4394
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant