Basic Information
| Provider Information | |||||||||
| NPI: | 1043467608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANSKY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | STELLA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 BASSWOOD CIRCLE NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GEORGIA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 4043673014 | ||||||||
| FaxNumber: | 4043673558 | ||||||||
| Practice Location | |||||||||
| Address1: | 3180 N POINT PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048005181 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | RN187265 | GA | N | Hospitals | General Acute Care Hospital | 363LG0600X | RN187265 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2100X | RN187265 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.