Individual
MICHELLA GLENNA DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
Mailing address
1400 S GERMANTOWN RD, GERMANTOWN, TN 38138-2205
(901) 759-3100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4234
TN
363AS0400X
Surgical Physician Assistant
4234
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09376398
—
MS
05
—
Q069916
—
TN
Enumeration date
03/30/2020
Last updated
05/04/2023
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