MEDICARE: EMMA GRACE NICHOLSON M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	APC010634	GA

General Provider Information

NPI Number	:	1326836495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA GRACE NICHOLSON M.ED.

Provider Business Mailing Address
First Line	:	1206 SUMMIT PLACE DR UNIT 6
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2436
Country	:	US
Telephone Number	:	770-722-3553
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 PKWY NORTH BLVD STE D
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8255
Country	:	US
Telephone Number	:	404-388-3909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	09/16/2025

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