Provider Demographics
NPI:1528594017
Name:LIMA, MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LIMA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33B ETOWAH RDG
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8652
Mailing Address - Country:US
Mailing Address - Phone:201-757-2277
Mailing Address - Fax:
Practice Address - Street 1:33B ETOWAH RDG
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8652
Practice Address - Country:US
Practice Address - Phone:201-757-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer