Provider Demographics
NPI:1508669060
Name:MICHEL, EDWIGE
Entity type:Individual
Prefix:
First Name:EDWIGE
Middle Name:
Last Name:MICHEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW STE 510
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4849
Mailing Address - Country:US
Mailing Address - Phone:770-875-8889
Mailing Address - Fax:
Practice Address - Street 1:1068 MERCHANTS DR APT 424
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-2969
Practice Address - Country:US
Practice Address - Phone:706-784-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant