Provider Demographics
NPI:1689676587
Name:HOUSTON, MICHELE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:C
Last Name:HOUSTON
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 1:980 JOHNSON FERRY RD NE
Mailing Address - Street 2:#720
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-252-3898
Mailing Address - Fax:404-843-0719
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:#720
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-252-3898
Practice Address - Fax:404-843-0719
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA41442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG98381Medicare UPIN
GA16BDTLKMedicare ID - Type Unspecified