Provider Demographics
NPI:1477565810
Name:EDWARDS-PASCHAL, MICHELE T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:T
Last Name:EDWARDS-PASCHAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:T
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4851 RUSSELL PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4851 RUSSELL PKWY STE 500
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9305
Practice Address - Country:US
Practice Address - Phone:470-765-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA715982648AMedicaid
GAI60786Medicare UPIN