Individual
MICHELLE R SHOULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
545 OLD NORCROSS RD STE 300, LAWRENCEVILLE, GA 30045-3390
(770) 963-6300
(678) 287-1664
Mailing address
545 OLD NORCROSS RD STE 300, LAWRENCEVILLE, GA 30045-3390
(770) 963-6300
(678) 287-1664
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004938
GA
363AS0400X
Surgical Physician Assistant
004938
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004938
GEORGIA LICENSE NUMBER
GA
Enumeration date
11/02/2006
Last updated
04/16/2010
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