Provider Demographics
NPI:1265476055
Name:MOORFIELD, MICHELLE MARIE (MMSC, RD, PA-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:MOORFIELD
Suffix:
Gender:F
Credentials:MMSC, RD, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:205 GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4940
Mailing Address - Country:US
Mailing Address - Phone:404-354-0132
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:ROOM11C-136
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-7782
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA003802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant