Provider Demographics
NPI:1932361185
Name:KAUSS, MICHELLE S (AA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:KAUSS
Suffix:
Gender:F
Credentials:AA
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:K
Other - Last Name:SOMMERS
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:180 NORTHLAND RIDGE TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2467
Mailing Address - Country:US
Mailing Address - Phone:404-751-6011
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:770-645-9181
Practice Address - Fax:770-645-8455
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA788256335BMedicaid
GA788256335AMedicaid
GA788256335BMedicaid