Provider Demographics
NPI:1558588111
Name:PICKETT, MICHELE ALBURY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ALBURY
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3304
Mailing Address - Country:US
Mailing Address - Phone:423-624-4846
Mailing Address - Fax:423-624-4847
Practice Address - Street 1:2507 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3304
Practice Address - Country:US
Practice Address - Phone:423-624-4846
Practice Address - Fax:423-624-4847
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26074208000000X
GA047936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG04990Medicare UPIN