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Contact Information

ANGELA E NICHOLAS
1909 SUMMERCOURT DR BLDG 19
JONESBORO, GA30236-1525
 Phone: 404-820-8100
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Private Vehicle

347C00000X
Indicates primary specialty

NPI Profile & details for

NPI Number 1124987664
Entity Organization
Organization subpart 1 Not specified
Enumeration date 01/20/2026
Last updated 01/20/2026 - About 5 months ago
Identifiers
GA License # 055633269
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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