Healthcare Provider Details

I. General information

NPI: 1700293701
Provider Name (Legal Business Name): NUKTE NICKY F ALTIKULAC BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 OLD ALABAMA RD STE 1110
ROSWELL GA
30076-2269
US

IV. Provider business mailing address

1875 OLD ALABAMA RD STE 1110
ROSWELL GA
30076-2269
US

V. Phone/Fax

Practice location:
  • Phone: 770-674-4106
  • Fax: 678-302-3453
Mailing address:
  • Phone: 404-394-3382
  • Fax: 678-302-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-14-5965
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: