Healthcare Provider Details

I. General information

NPI: 1164465985
Provider Name (Legal Business Name): NICOLA C CHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

IV. Provider business mailing address

720 WESTVIEW DRIVE SW HARRIS BLDG., 100-A
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9850
  • Fax:
Mailing address:
  • Phone: 404-756-1400
  • Fax: 770-507-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number044429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: