Individual
NICOLE A WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3180 MATHIESON DR NE UNIT 706, ATLANTA, GA 30305-1868
(949) 355-5017
Mailing address
3180 MATHIESON DR NE UNIT 706, ATLANTA, GA 30305-1868
(949) 355-5017
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9116808
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/05/2022
Last updated
05/11/2023
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