Individual
NICOLE SAMIRA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-1000
(706) 721-4951
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(067) 721-4951
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11945
GA
Other
Enumeration date
02/27/2019
Last updated
07/30/2024
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