Michelle R Shoultz, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004938 Issued in GA

Practice address

545 Old Norcross Rd Ste 300
Lawrenceville, GA 30045-3390

Phone

(770) 963-6300

Fax

(678) 287-1664

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271376000000",
    "number": "1457439747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 OLD NORCROSS RD STE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453390",
            "telephone_number": "770-963-6300",
            "fax_number": "678-287-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 OLD NORCROSS RD STE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453390",
            "telephone_number": "770-963-6300",
            "fax_number": "678-287-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOULTZ",
        "first_name": "MICHELLE",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2010-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004938",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "004938",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA LICENSE NUMBER",
            "identifier": "004938",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shivdharaa LLC
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• David W. Shonkoff, MD
• David Anthony Shore, M.D.
• Lewaa Shoujaa, MD
• Connie Hall Shrake, M.D.
• Kevin Shrake, MD
• Philip Shrake, MD
• Christopher Shriver
• Kenneth Shults Jr., R.N.

• Medical Physician Assistant in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.