Individual
ANGELA NICOLE NIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
724 BEAVERS RD, CANTON, GA 30115-6138
(404) 247-0174
Mailing address
724 BEAVERS RD, CANTON, GA 30115-6138
(404) 247-0174
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT008404
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511I650397
MEDICARE PTAN
GA
Enumeration date
10/15/2008
Last updated
09/26/2013
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