Individual
MRS. NICOLE LINDSTROM BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(678) 819-0357
Mailing address
61 WHITCHER ST NE, SUITE 4100, MARIETTA, GA 30060-1176
(770) 424-6893
(770) 424-9095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005996
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003107812A
—
GA
Enumeration date
11/09/2010
Last updated
03/27/2014
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