Basic Information
| Provider Information | |||||||||
| NPI: | 1922058163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARP | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.M. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1942 ATKINSON RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300435004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787750600 | ||||||||
| FaxNumber: | 6783775284 | ||||||||
| Practice Location | |||||||||
| Address1: | 1942 ATKINSON RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300435004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787750600 | ||||||||
| FaxNumber: | 6783775284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | RN126964 | GA | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 271216748A | 05 | GA | MEDICAID |