Provider Demographics
NPI:1407590771
Name:WEIR, MICHELL GENEA (CNA)
Entity Type:Individual
Prefix:
First Name:MICHELL
Middle Name:GENEA
Last Name:WEIR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 BARRINGTON VW
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1846
Mailing Address - Country:US
Mailing Address - Phone:678-582-9317
Mailing Address - Fax:
Practice Address - Street 1:1607 BARRINGTON VW
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1846
Practice Address - Country:US
Practice Address - Phone:678-582-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030044609376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9576376OtherCIGNA