Individual
NICHOLAS MILDENHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
699 CHURCH ST NE STE 340, MARIETTA, GA 30060-1131
(678) 355-1620
Mailing address
699 CHURCH ST NE STE 340, MARIETTA, GA 30060-1131
(678) 355-1620
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
84505
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2015
Last updated
08/27/2020
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