Michelle Renee Widows, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY6699 Issued in FL

Practice address

515 City Blvd Ste B
Waycross, GA 31501-8016

Phone

(912) 249-4400

Fax

(912) 279-4448

NPI assigned

Sep 10, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other names 1

• Dr. Michelle Renee Widows Moore Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Florida Health Professions Association, Inc.

  • Clinical Psychologist
  • Gainesville, FL
  • NPI 1932125556
  NPD (past)

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

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1679806533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 CITY BLVD STE B",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315018016",
            "telephone_number": "912-249-4400",
            "fax_number": "912-279-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 CITY BLVD STE B",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315018016",
            "telephone_number": "912-249-4400",
            "fax_number": "912-279-4448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDOWS",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-10",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "3155",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6699",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "3155",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "FL",
            "license": "PY669",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "CO",
            "license": "3155",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY6699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "MOORE",
            "middle_name": "RENEE WIDOWS",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• George A Wheeler, M.D.
• Theresa Wheeler, LPN
• Ashley Nicole White, FNP-C
• Carlos Cortez White
• Dalton White
• Tammy Wiggins, NP
• Jason E Wilkerson
• Donnetta Wilkinson, LPN
• William C Hurst, Sr., D.M.D., P.C.
• William Keith Crummey DMD PC

• Clinical Psychologist in Waycross, GA
• Providers in Waycross, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.