Healthcare Provider Details

I. General information

NPI: 1649715731
Provider Name (Legal Business Name): NIKKI BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 CUMBERLAND PKWY SE 3711
ATLANTA GA
30339-6136
US

IV. Provider business mailing address

2451 CUMBERLAND PKWY SE 3711
ATLANTA GA
30339-6136
US

V. Phone/Fax

Practice location:
  • Phone: 678-733-6466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO094395
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: