Individual
MS. NICOLE LEE KHOURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
960 JOHNSON FERRY ROAD, SUITE 200 ADVANCED ENT, PC, ATLANTA, GA 30342
(404) 943-0900
(404) 943-1390
Mailing address
960 JOHNSON FERRY ROAD, SUITE 200 ADVANCED ENT, PC, ATLANTA, GA 30342
(404) 943-0900
(404) 943-1390
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97WCCMF
CARRIER PROVIDER NUMBER
GA
Enumeration date
03/22/2007
Last updated
05/26/2011
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