Healthcare Provider Details

I. General information

NPI: 1174167639
Provider Name (Legal Business Name): NICOLA NATALIE WATSON CONDUAH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLA NATALIE WATSON CONDUAH FNP-C

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 ATLANTA HWY STE 105
CUMMING GA
30040-6339
US

IV. Provider business mailing address

PO BOX 4232
ALPHARETTA GA
30023-4232
US

V. Phone/Fax

Practice location:
  • Phone: 678-860-8844
  • Fax: 770-886-9908
Mailing address:
  • Phone: 678-860-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN250366
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: