Provider Demographics
NPI:1760981609
Name:MICHELLE ZEANAH MD PC
Entity Type:Organization
Organization Name:MICHELLE ZEANAH MD PC
Other - Org Name:BEHAVIORAL PEDIATRICS OF RURAL GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:ZEANAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-489-4379
Mailing Address - Street 1:406 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5102
Mailing Address - Country:US
Mailing Address - Phone:912-489-4379
Mailing Address - Fax:912-681-4379
Practice Address - Street 1:406 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5102
Practice Address - Country:US
Practice Address - Phone:912-489-4379
Practice Address - Fax:912-681-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
GA56388261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No251S00000XAgenciesCommunity/Behavioral Health