Individual
NICOYA BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
PO BOX 392376, SNELLVILLE, GA 30039-0040
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
167569
GA
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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