Healthcare Provider Details

I. General information

NPI: 1194355859
Provider Name (Legal Business Name): NYESHIA SHERELLE COHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5185 OLD NATIONAL HWY
COLLEGE PARK GA
30349-3244
US

IV. Provider business mailing address

1040 HUFF RD NW APT 1401
ATLANTA GA
30318-4168
US

V. Phone/Fax

Practice location:
  • Phone: 404-763-9300
  • Fax:
Mailing address:
  • Phone: 205-903-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2290096
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNCO-000001
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: