Provider Demographics
NPI:1023081015
Name:WINHAM, MICHELLE D (ATC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:WINHAM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 ASHWOODY TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1406
Mailing Address - Country:US
Mailing Address - Phone:679-997-1616
Mailing Address - Fax:
Practice Address - Street 1:314 N BROAD ST
Practice Address - Street 2:SUITE 340
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2191
Practice Address - Country:US
Practice Address - Phone:770-867-2120
Practice Address - Fax:770-867-2140
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0011242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer