Provider Demographics
NPI:1932102910
Name:CRAVEY, MICHELLE DEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DEE
Last Name:CRAVEY
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 1:1100 WOODVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-7513
Mailing Address - Country:US
Mailing Address - Phone:478-374-1130
Mailing Address - Fax:478-374-1093
Practice Address - Street 1:718 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6715
Practice Address - Country:US
Practice Address - Phone:478-374-1130
Practice Address - Fax:478-374-1093
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA042223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41177Medicare UPIN