Provider Demographics
NPI:1902818032
Name:MORANTE, MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MORANTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 MCCLURE BRIDGE RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6675
Mailing Address - Country:US
Mailing Address - Phone:678-957-8801
Mailing Address - Fax:678-957-8804
Practice Address - Street 1:3400 MCCLURE BRIDGE RD
Practice Address - Street 2:BUILDING B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6675
Practice Address - Country:US
Practice Address - Phone:678-957-8801
Practice Address - Fax:678-957-8804
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP18503Medicare UPIN
GA97BBGFBMedicare ID - Type Unspecified