Healthcare Provider Details

I. General information

NPI: 1538908488
Provider Name (Legal Business Name): NIKI ZOKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 MAIN ST
COLLEGE PARK GA
30337-3655
US

IV. Provider business mailing address

3005 PEACHTREE RD NE UNIT 1216
ATLANTA GA
30305-2581
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-6775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123400
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: