Provider Demographics
NPI:1447294939
Name:MAYHUE, MICHELLE D (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:MAYHUE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2825
Mailing Address - Country:US
Mailing Address - Phone:478-743-9762
Mailing Address - Fax:478-746-6612
Practice Address - Street 1:575 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2825
Practice Address - Country:US
Practice Address - Phone:478-743-9762
Practice Address - Fax:478-746-6612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00283084OtherRAILROAD
GA50BBJVJMedicare ID - Type Unspecified
GAQ49672Medicare UPIN