Provider Demographics
NPI:1164622924
Name:DEEVES, MICHELLE LYNNE (DO)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:DEEVES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:908 HILLCREST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021
Mailing Address - Country:US
Mailing Address - Phone:478-272-7411
Mailing Address - Fax:478-274-9809
Practice Address - Street 1:908 HILLCREST PARKWAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-7411
Practice Address - Fax:478-274-9809
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002482207Q00000X
GA64204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA620837830AMedicaid