Provider Demographics
NPI:1225730187
Name:FUERSTENAU, NICHOLAS JESSE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JESSE
Last Name:FUERSTENAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SUMMERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-1534
Mailing Address - Country:US
Mailing Address - Phone:678-739-8565
Mailing Address - Fax:
Practice Address - Street 1:501 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-291-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program