Healthcare Provider Details

I. General information

NPI: 1932864683
Provider Name (Legal Business Name): NICHELLE LOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 10/05/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W ROOSEVELT AVE STE 410
ALBANY GA
31701-2639
US

IV. Provider business mailing address

2800 OLD DAWSON ROAD SUITE 2 #275
ALBANY GA
31707
US

V. Phone/Fax

Practice location:
  • Phone: 229-302-8241
  • Fax:
Mailing address:
  • Phone: 229-302-8241
  • Fax: 762-266-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: