MEDICARE: JOHN NINO MD

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	207Y00000X	Otolaryngology Physician	045901	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689670804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NINO MD

Provider Business Mailing Address
First Line	:	6002 PROFESSIONAL PKWY
Second Line	:	SUITE 100
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5600
Country	:	US
Telephone Number	:	770-949-4200
Fax Number	:	770-949-5553

Provider Business Practice Location Address
First Line	:	6002 PROFESSIONAL PKWY
Second Line	:	SUITE 100
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5600
Country	:	US
Telephone Number	:	770-949-4200
Fax Number	:	770-949-5553

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/30/2011

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Directions to “ JOHN NINO MD” Practice Location

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