Healthcare Provider Details

I. General information

NPI: 1013066323
Provider Name (Legal Business Name): APRIL NICHOLS C.S.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/11/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 COPPERHEAD RD SE
ACWORTH GA
30102-2736
US

IV. Provider business mailing address

PO BOX 2490
ACWORTH GA
30102-0009
US

V. Phone/Fax

Practice location:
  • Phone: 229-575-7291
  • Fax:
Mailing address:
  • Phone: 229-575-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number2899
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: