Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | GA72427 | GA |
N | 207VG0400X | Gynecologist | MD0000046779 | TN |
NPI | 1508155268 |
---|---|
Provider Name | Nicklaus Trent Rice |
First Address | Conyers, GA 30094-3991 |
Second Address | Conyers, GA 30094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 13/11/2019 |