Healthcare Provider Details

I. General information

NPI: 1275497364
Provider Name (Legal Business Name): CYNTHIA JOAN NIST MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 4201
BERKELEY LAKE GA
30071-5738
US

IV. Provider business mailing address

4720 PEACHTREE INDUSTRIAL BLVD STE 4201
BERKELEY LAKE GA
30071-5738
US

V. Phone/Fax

Practice location:
  • Phone: 404-900-9583
  • Fax:
Mailing address:
  • Phone: 404-900-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: