Individual
NICOLE MIDDLEBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EMT-I
Contact information
Practice address
1174 FOREST PKWY, LAKE CITY, GA 30260-3471
(678) 878-9834
Mailing address
PO BOX 1132, FOREST PARK, GA 30298-1132
(678) 878-9834
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
GA
146M00000X
Intermediate Emergency Medical Technician
—
GA
172A00000X
Driver
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
39499
GA
372600000X
Adult Companion
—
—
Other
Enumeration date
08/10/2017
Last updated
08/10/2017
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