=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174167639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLA NATALIE WATSON CONDUAH FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2019
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 ATLANTA HWY STE 105
-----------------------------------------------------
City | CUMMING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30040-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-860-8844
-----------------------------------------------------
Fax | 770-886-9908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4232
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30023-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-860-8844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN250366
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------