Healthcare Provider Details

I. General information

NPI: 1982233227
Provider Name (Legal Business Name): KAYLA ANNE NICHOLS PHARMD, BCCCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

361 17TH ST NW UNIT 2013
ATLANTA GA
30363-1090
US

V. Phone/Fax

Practice location:
  • Phone: 904-392-9588
  • Fax:
Mailing address:
  • Phone: 904-392-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberRPH029229
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: