Provider Demographics
NPI:1295503191
Name:MCMICHAEL, ANNETTE RAQUEL (CSFA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RAQUEL
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 OLD PENDERGRASS RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2763
Mailing Address - Country:US
Mailing Address - Phone:706-870-9366
Mailing Address - Fax:
Practice Address - Street 1:1182 OLD PENDERGRASS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2763
Practice Address - Country:US
Practice Address - Phone:706-870-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100264350246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant