Provider Demographics
NPI:1154314771
Name:NEAL, MICHELE E (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:E
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:EVYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3091 KIRBY WHITTEN PKWY
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-759-4704
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28201207Q00000X
MS15282207Q00000X, 207Q00000X
ARC-8427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7752190OtherCIGNA
TN3048747OtherBCBS, TN
TN140437OtherUNITED HEALTHCARE
TN5982182OtherAETNA
TN3803561Medicare PIN
TN7752190OtherCIGNA
F70762Medicare UPIN