Healthcare Provider Details

I. General information

NPI: 1760346092
Provider Name (Legal Business Name): MICHELLE NICOLE NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 SABLE BAY PT
ATLANTA GA
30349-8812
US

IV. Provider business mailing address

5625 SABLE BAY PT
ATLANTA GA
30349-8812
US

V. Phone/Fax

Practice location:
  • Phone: 470-213-1919
  • Fax:
Mailing address:
  • Phone: 470-213-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: