NPIMap

Individual provider Active NPI

Michelle M Williams, PA-C

  • Physician Assistant
  • Ellenwood, GA
National Provider Identifier
1356433452
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2314 Issued in GA
Practice address
4475 W Village Pkwy
Ellenwood, GA 30294-2869
Phone
(770) 507-7950
Fax
(716) 710-8082
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 2314 GA Primary

Addresses

Primary practice location

4475 W Village Pkwy
Ellenwood, GA 30294-2869

Mailing address

7830 Bleusparrow Dr
Fairburn, GA 30213-6541
Phone (678) 665-5175

Other practice location 1

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031
Phone (404) 616-4307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031121000128 GA Practitioner - Physician Assistant 9436053493 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
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)

1909 N Columbia St
Milledgeville, GA 31061-2170
Phone (478) 354-4250

2292 Peachtree Rd
Atlanta, GA 30309-1147
Phone (404) 382-9941

4475 W Village Pkwy
Ellenwood, GA 30294-2869
Phone (770) 507-7950

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002314GAMDNeurology Physician
2314GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care, P.a. CurrentSince Aug 27, 2025 Accepting new patients
Grady Memorial Hospital Corporation CurrentSince Dec 1, 2013 Accepting new patients
American Current Care P.a. CurrentSince Aug 27, 2025 Accepting new patients
American Current Care PA CurrentSince Aug 27, 2025 Accepting new patients
Emory Medical Care Foundation CurrentSince Nov 2, 2002 Accepting new patients
Grady Memorial Hospital Corporation CurrentSince Dec 1, 2013 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Nov 2, 2002 Accepting new patients
Surgical Assistants of America, Inc. Past Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

688 Spring St NW
Atlanta, GA 30308
Phone (404) 881-1155

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

1595 Cleveland Ave
East Point, GA 30344
Phone (404) 305-8086

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1356433452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7830 BLEUSPARROW DR",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302136541",
            "telephone_number": "678-665-5175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 W VILLAGE PKWY",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942869",
            "telephone_number": "770-507-7950",
            "fax_number": "716-710-8082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Jesse Hill Jr Dr SE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303033031",
            "country_code": "US",
            "telephone_number": "404-616-4307",
            "fax_number": "404-616-8022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MICHELLE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "2314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellenwood, GA

Sources for this page

Verify at the official NPI Registry.