Healthcare Provider Details

I. General information

NPI: 1053841866
Provider Name (Legal Business Name): NICHOLAS BRANDON LEMASTER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 N DECATUR RD STE 320
DECATUR GA
30033-6136
US

IV. Provider business mailing address

2345 PEACHWOOD CIR NE APT 5109
ATLANTA GA
30345-8041
US

V. Phone/Fax

Practice location:
  • Phone: 404-856-3550
  • Fax:
Mailing address:
  • Phone: 256-468-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN22740
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN22740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: