Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT002470 | GA |
Y | 213ES0000X | Sports Medicine | AT002470 | GA |
NPI | 1205477635 |
---|---|
Provider Name | Nicole Thomas |
First Address | Buford, GA 30518-8627 |
Second Address | Milton, GA 30004-7306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2019 |
Last Update Date | 07/10/2019 |