Healthcare Provider Details

I. General information

NPI: 1477280303
Provider Name (Legal Business Name): MRS. NICOLE CHRISTINE BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 DEPUTY BILL CANTRELL MEM
CUMMING GA
30040-3069
US

IV. Provider business mailing address

3970 DEPUTY BILL CANTRELL MEM
CUMMING GA
30040-3069
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax: 678-513-8869
Mailing address:
  • Phone: 678-513-2273
  • Fax: 678-513-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031971
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberRN321455
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: