Provider Demographics
NPI:1245603844
Name:NICHOLS-BATES, SHANTRICE BERNICE (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:SHANTRICE
Middle Name:BERNICE
Last Name:NICHOLS-BATES
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 JONESBORO RD STE A2-314
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2050
Mailing Address - Country:US
Mailing Address - Phone:470-316-8028
Mailing Address - Fax:
Practice Address - Street 1:4550 JONESBORO RD STE A2-314
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2050
Practice Address - Country:US
Practice Address - Phone:470-316-8028
Practice Address - Fax:678-519-2736
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS901369363LF0000X
OR201508267NP-PP363LF0000X
GAGAA-NP000049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily