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General NPI Number Information
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NPI Number | 1760503692
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Entity Type | Organization
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Legal Business Name | NOLSVOLS INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 11255 WOODSTOCK ROAD SUITE 200
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City | ROSWELL
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State | GA
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Zip | 30075
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Country | US
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Telephone | 770-594-8011
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Fax | 770-594-8012
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Provider Business Mailing Address
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Address Line | 11255 WOODSTOCK ROAD SUITE 200
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City | ROSWELL
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State | GA
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Zip | 30075
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Country | US
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Telephone | 770-594-8011
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Fax | 770-594-8012
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. RANDY RANDOLPH WILLIAM SPARKS
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Credential | CERIFIED PEDORTHISTS
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Telephone | 770-594-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 105632
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License Number State | GA
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