Provider Demographics
NPI:1730139197
Name:STAUFFENBERG, MICHELE T (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:T
Last Name:STAUFFENBERG
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:FULTON COUNTY MEDICAL EXAMINERS OFFICE
Mailing Address - Street 2:430 PRYOR ST.
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:404-730-4400
Mailing Address - Fax:404-730-4405
Practice Address - Street 1:FULTON COUNTY MEDICAL EXAMINERS OFFICE
Practice Address - Street 2:430 PRYOR ST.
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-730-4400
Practice Address - Fax:404-730-4405
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049478207ZF0201X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Not Answered207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA049478OtherMEDICAL LICENSE