Provider Demographics
NPI:1629598016
Name:HOSANG, MICHELLE MISHA D (NP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MISHA D
Last Name:HOSANG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W PEACHTREE ST NE UNIT 324
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4617
Mailing Address - Country:US
Mailing Address - Phone:678-464-0786
Mailing Address - Fax:
Practice Address - Street 1:1045 SYCAMORE DR FL 2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1645
Practice Address - Country:US
Practice Address - Phone:404-501-7081
Practice Address - Fax:404-419-1680
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily