Michelle Elizabeth Dehaven

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

12342 Issued in GA

Practice address

115 Cherry St NE
Marietta, GA 30060-7205

Phone

(770) 793-5700

NPI assigned

Oct 18, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment Care Compare group
• The Bortolazzo Group, LLC

  • Emergency Medicine Physician
  • Austell, GA
  • NPI 1801965082
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1083330351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4238 STERLING POINTE DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607205",
            "telephone_number": "770-793-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3093 Flowers Rd S Apt N",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303415655",
            "country_code": "US",
            "telephone_number": "570-460-1986",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3093 Flowers Rd S Apt N",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303415655",
            "country_code": "US",
            "telephone_number": "570-460-1986",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4238 Sterling Pointe Dr",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301355037",
            "country_code": "US",
            "telephone_number": "570-460-1986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEHAVEN",
        "first_name": "MICHELLE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-18",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "12342",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David H Deckner-Glick, MSW, LCSW
• Dedicated Kare LLC
• Dedicated Personal Care Home
• Lindsay Michelle Deere, PHYSICAL THERAPIST P
• Angelo Nicholas Deguerre
• Valdesha Lechante' Dejean, M.D.
• Jorge Del Cuadro
• Marina Delaine-Siegel, MA
• Chikosia Lacole Delaney
• Delcine & Kree Solutions

• Emergency Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.