Healthcare Provider Details

I. General information

NPI: 1902720154
Provider Name (Legal Business Name): NIKITRESS MCGILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6572 RIVER PARK DR STE 101
RIVERDALE GA
30274-2214
US

IV. Provider business mailing address

7001 CLEMENTINE TRL APT 7209
FAIRBURN GA
30213-6616
US

V. Phone/Fax

Practice location:
  • Phone: 678-626-1833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: