Provider Demographics
NPI:1710099429
Name:PERRY, MICHELLE YVONNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVONNE
Last Name:PERRY
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 1:2060 DAN PROCTOR DR
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3894
Mailing Address - Country:US
Mailing Address - Phone:912-510-7376
Mailing Address - Fax:912-510-7377
Practice Address - Street 1:2060 DAN PROCTOR DR
Practice Address - Street 2:SUITE 1800
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3894
Practice Address - Country:US
Practice Address - Phone:912-510-7376
Practice Address - Fax:912-510-7377
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53017207V00000X
TNMD0000036799207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH86262Medicare UPIN
TN3732557Medicare ID - Type UnspecifiedGROUP NUMBER