Individual
JOHN NINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6002 PROFESSIONAL PKWY, SUITE 100, DOUGLASVILLE, GA 30134-5600
(770) 949-4200
(770) 949-5553
Mailing address
6002 PROFESSIONAL PKWY, SUITE 100, DOUGLASVILLE, GA 30134-5600
(770) 949-4200
(770) 949-5553
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
045901
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000799202A
—
GA
Enumeration date
06/22/2005
Last updated
06/30/2011
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