Healthcare Provider Details

I. General information

NPI: 1366862492
Provider Name (Legal Business Name): NICOLE ZELENSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE OFC 314
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE OFC 314
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1550
  • Fax: 404-778-1552
Mailing address:
  • Phone: 404-778-1550
  • Fax: 404-778-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number89777
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number66057
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number89777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: