Provider Demographics
NPI:1992196265
Name:MCMICHAEL, LEISA (RN)
Entity Type:Individual
Prefix:
First Name:LEISA
Middle Name:
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5107
Mailing Address - Fax:706-270-5010
Practice Address - Street 1:1 WOODBINE AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2397
Practice Address - Country:US
Practice Address - Phone:706-314-0019
Practice Address - Fax:706-314-0343
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse