Provider Demographics
NPI:1528177201
Name:EBERLY, MICHELLE REGISTER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:REGISTER
Last Name:EBERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 102546
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-5467
Mailing Address - Country:US
Mailing Address - Phone:251-943-1680
Mailing Address - Fax:251-943-1683
Practice Address - Street 1:1703 N BUNNER ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2229
Practice Address - Country:US
Practice Address - Phone:251-943-1680
Practice Address - Fax:251-943-1683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL21261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HO5624Medicare UPIN