Healthcare Provider Details

I. General information

NPI: 1013626928
Provider Name (Legal Business Name): NOMIKI NIKITADENA CATSULIS APRN, PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 GA-20 SUITE 203
SUGAR HILL GA
30518
US

IV. Provider business mailing address

4720 OUTLOOK WAY NE
MARIETTA GA
30066-1790
US

V. Phone/Fax

Practice location:
  • Phone: 470-589-7555
  • Fax:
Mailing address:
  • Phone: 727-557-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN218569
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: