Basic Information
| Provider Information | |||||||||
| NPI: | 1689676587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 JOHNSON FERRY RD NE | ||||||||
| Address2: | #720 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042523898 | ||||||||
| FaxNumber: | 4048430719 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 JOHNSON FERRY RD NE | ||||||||
| Address2: | #720 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042523898 | ||||||||
| FaxNumber: | 4048430719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 41442 | GA | Y | Other Service Providers | Specialist |
No ID Information.