Provider Demographics
NPI:1356433452
Name:WILLIAMS, MICHELLE M (PA-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 BLEUSPARROW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6541
Mailing Address - Country:US
Mailing Address - Phone:678-665-5175
Mailing Address - Fax:
Practice Address - Street 1:4475 W VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2869
Practice Address - Country:US
Practice Address - Phone:770-507-7950
Practice Address - Fax:716-710-8082
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
GA2314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical