Provider Demographics
NPI:1902024797
Name:COVALT, MICHELLE ANGIE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGIE
Last Name:COVALT
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:719-380-8087
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD
Practice Address - Street 2:KAISER PERMANENTE GWINNETT COMPREHENSIVE MEDICAL CENTER
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4506
Practice Address - Country:US
Practice Address - Phone:770-496-3419
Practice Address - Fax:719-380-8087
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO49001207V00000X
GA076803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60839279Medicaid
CO60839279Medicaid