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NPI Code Detail

MEDICARE: NILSA I. NAZARIO MD

MEDICARE: NILSA I. NAZARIO 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
1208000000XPediatrics Physician30356GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130356OTHERGAGEORGIA MEDICAL LICENSE

General Provider Information

NPI Number : 1891771408
Entity Type Code : Individual
Provider Name (Legal Business Name) : NILSA I. NAZARIO MD
Provider Business Mailing Address
First Line : 4905 COURTNEY DR
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-1427
Country : US
Telephone Number : 404-366-3636
Fax Number : 404-362-0808
Provider Business Practice Location Address
First Line : 4905 COURTNEY DR
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-1427
Country : US
Telephone Number : 404-366-3636
Fax Number : 404-362-0808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2005
Last Update Date : 11/17/2021

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Directions to “ NILSA I. NAZARIO MD” Practice Location

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