Healthcare Provider Details

I. General information

NPI: 1013626928
Provider Name (Legal Business Name): NOMIKI NIKITADENA CATSULIS APRN, PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

4720 OUTLOOK WAY NE
MARIETTA GA
30066-1790
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-4000
  • Fax:
Mailing address:
  • Phone: 727-557-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN218569
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: