Provider Demographics
NPI:1609905959
Name:SIPP, NIA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NIA
Middle Name:MICHELLE
Last Name:SIPP
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 1:733 CHEROKEE AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1417
Mailing Address - Country:US
Mailing Address - Phone:678-631-7993
Mailing Address - Fax:404-759-2288
Practice Address - Street 1:733 CHEROKEE AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1417
Practice Address - Country:US
Practice Address - Phone:410-409-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA613472084P0804X, 2084P0802X, 2084P0800X
SC882372084P0804X
AZ468672084P0804X, 2084P0800X, 2084P0802X
SC882732084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110138AMedicaid