Individual
DR. JEFFREY EVAN MICHAELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 WHITCHER ST NE, SUITE 160, MARIETTA, GA 30060-1155
(770) 422-1372
(770) 423-9651
Mailing address
55 WHITCHER ST NE, SUITE 160, MARIETTA, GA 30060-1155
(770) 422-1372
(770) 423-9651
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
037623
GA
207RP1001X
Pulmonary Disease Physician
Primary
037623
GA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
37623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00645147C
—
GA
01
—
0932200001
WORKERS COMPENSATION
GA
01
—
202I294296
MEDICARE PTAN
GA
01
—
290012142
RAILROAD MEDICARE
GA
01
—
2999766
GHI
—
01
—
4820111
UNITED HEALTHCARE
—
01
—
5341107
AETNA
—
01
—
58-1831482
FEDERAL TAX IDENTIFICATION NUMBER
GA
01
—
5932
KAISER
GA
01
—
6054810006
CIGNA
—
01
—
767305
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/29/2005
Last updated
10/17/2019
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