Provider Demographics
NPI:1902256027
Name:NISBETH, ZALIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:ZALIKA
Middle Name:
Last Name:NISBETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 COMMERCIAL DR STE C8
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3633
Mailing Address - Country:US
Mailing Address - Phone:904-833-8325
Mailing Address - Fax:904-585-7341
Practice Address - Street 1:315 COMMERCIAL DR STE C8
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3633
Practice Address - Country:US
Practice Address - Phone:904-833-8325
Practice Address - Fax:904-585-7341
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135573207Q00000X
GA85501261QP2300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003233968AMedicaid