Provider Demographics
NPI:1730526542
Name:JOHN, NICOLE STEPHANIE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:STEPHANIE
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1700 HOSPITAL SOUTH DR STE 500
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8159
Mailing Address - Country:US
Mailing Address - Phone:770-941-7717
Mailing Address - Fax:770-948-9729
Practice Address - Street 1:1700 HOSPITAL SOUTH DR STE 500
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8159
Practice Address - Country:US
Practice Address - Phone:770-941-7717
Practice Address - Fax:770-948-9729
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2886281207V00000X
GA84390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology