Healthcare Provider Details

I. General information

NPI: 1902760804
Provider Name (Legal Business Name): NICK BROMFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 OLYMPIC DR
ATHENS GA
30601-1633
US

IV. Provider business mailing address

3151 SLOPING TER
SNELLVILLE GA
30078-3150
US

V. Phone/Fax

Practice location:
  • Phone: 904-456-1204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: