Provider Demographics
NPI:1114647476
Name:SCHOETTLER, NICOLE (CAA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHOETTLER
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KESWICK WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6315
Mailing Address - Country:US
Mailing Address - Phone:770-329-5388
Mailing Address - Fax:
Practice Address - Street 1:5671 PEACHTREE DUNWOODY RD STE 530
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-5005
Practice Address - Country:US
Practice Address - Phone:404-257-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant