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General NPI Number Information
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NPI Number | 1518221704
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Entity Type | Individual
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Provider Name | RYAN NICHOLAS NOLTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 711 CANTON RD NE STE 220
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City | MARIETTA
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State | GA
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Zip | 30060-8949
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Country | US
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Telephone | 404-554-2196
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Fax | 404-554-2415
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Provider Business Mailing Address
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Address Line | 839 INMAN VILLAGE PKWY NE
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City | ATLANTA
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State | GA
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Zip | 30307-5501
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Country | US
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Telephone | 251-689-2906
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Fax | 217-545-2563
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 86721
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036143834
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME147110
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 125.061434
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License Number State | IL
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