Provider Demographics
NPI:1477565810
Name:EDWARDS-PASCHAL, MICHELE T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:T
Last Name:EDWARDS-PASCHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:T
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5437 BOWMAN RD STE 126
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-6574
Mailing Address - Country:US
Mailing Address - Phone:478-633-1919
Mailing Address - Fax:478-633-1924
Practice Address - Street 1:5437 BOWMAN RD STE 126
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-6574
Practice Address - Country:US
Practice Address - Phone:478-633-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA715982648AMedicaid
GAI60786Medicare UPIN