Provider Demographics
NPI:1578044046
Name:HAN, MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2520 WINDY HILL RD SE STE 301
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8695
Mailing Address - Country:US
Mailing Address - Phone:770-952-1032
Mailing Address - Fax:770-952-7810
Practice Address - Street 1:2520 WINDY HILL RD SE STE 301
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8695
Practice Address - Country:US
Practice Address - Phone:770-952-1032
Practice Address - Fax:770-952-7810
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2020-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA8796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant