Individual
JACK ANTHONY MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
1825 MARTHA BERRY BLVD NW, ROME, GA 30165-1625
(762) 235-1470
(706) 238-8081
Mailing address
221 TECHNOLOGY PKWY NW, ROME, GA 30165-1369
(762) 235-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN242971
GA
Other
Enumeration date
03/05/2020
Last updated
10/24/2023
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