MEDICARE: VANESSA NILES 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	207V00000X	Obstetrics & Gynecology Physician	13889	SC
2	207V00000X	Obstetrics & Gynecology Physician	064619	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922199470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA NILES MD

Provider Business Mailing Address
First Line	:	75 PIEDMONT AVE NE
Second Line	:	STE 700
City	:	ATLANTA
State	:	GA
Zip	:	30303-2544
Country	:	US
Telephone Number	:	404-756-1403
Fax Number	:	404-756-5252

Provider Business Practice Location Address
First Line	:	1800 HOWELL MILL RD
Second Line	:	STE 275
City	:	ATLANTA
State	:	GA
Zip	:	30318-2508
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:	404-756-5252

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/06/2014

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Directions to “ VANESSA NILES MD” Practice Location

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