Provider Demographics
NPI:1649739814
Name:WHEELER, MICHELLE ANGELIQUE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELIQUE
Last Name:WHEELER
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 1:224 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4005
Mailing Address - Country:US
Mailing Address - Phone:662-299-0625
Mailing Address - Fax:
Practice Address - Street 1:950 MATTHEW DR STE 5
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2590
Practice Address - Country:US
Practice Address - Phone:601-735-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31771207QS0010X
TXS9828207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine