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General NPI Number Information
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NPI Number | 1013626928
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Entity Type | Individual
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Provider Name | NOMIKI NIKITADENA CATSULIS APRN, PNP-PC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 3950 AUSTELL RD
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City | AUSTELL
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State | GA
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Zip | 30106-1121
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Country | US
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Telephone | 770-732-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 OUTLOOK WAY NE
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City | MARIETTA
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State | GA
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Zip | 30066-1790
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Country | US
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Telephone | 727-557-5663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | RN218569
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License Number State | GA
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