Individual
NIDHA JIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1800 TREE LN STE 250, SNELLVILLE, GA 30078-6799
(770) 736-6300
Mailing address
410 MEIJER DR, FLORENCE, KY 41042-5128
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
11663
GA
363A00000X
Physician Assistant
Primary
11663
GA
Other
Enumeration date
06/12/2023
Last updated
09/22/2023
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