Provider Demographics
NPI:1629206503
Name:SHUMPERT, MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:SHUMPERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-1584
Mailing Address - Country:US
Mailing Address - Phone:404-910-3697
Mailing Address - Fax:404-910-3697
Practice Address - Street 1:1110 FARR RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-8628
Practice Address - Country:US
Practice Address - Phone:706-683-0909
Practice Address - Fax:706-683-9757
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003793207Q00000X
GA66322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine