Individual
KIM RICHARD NICOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2928 BUSBEE PKWY NW, 530, KENNESAW, GA 30144-4820
(770) 627-4950
(770) 627-4950
Mailing address
2928 BUSBEE PKWY NW, 530, KENNESAW, GA 30144-4820
(770) 627-4950
(770) 627-4950
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
027881
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00312375D
—
GA
Enumeration date
03/21/2007
Last updated
01/15/2008
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