Provider Demographics
NPI:1750678843
Name:SHIBLEY, MICHAEL VICTOR (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VICTOR
Last Name:SHIBLEY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:4791 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5324
Mailing Address - Country:US
Mailing Address - Phone:404-251-1600
Mailing Address - Fax:770-422-2340
Practice Address - Street 1:4791 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5324
Practice Address - Country:US
Practice Address - Phone:404-251-1600
Practice Address - Fax:770-422-2340
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2017-10-27
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Provider Licenses
StateLicense IDTaxonomies
GA006164363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical