Provider Demographics
NPI:1265687172
Name:NKOY, FRANCINE S (PA)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:S
Last Name:NKOY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHIDIGA
Other - Middle Name:FRANCINE
Other - Last Name:MATADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1192 ROCKBRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2923
Mailing Address - Country:US
Mailing Address - Phone:770-925-2010
Mailing Address - Fax:770-925-1665
Practice Address - Street 1:1192 ROCKBRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2923
Practice Address - Country:US
Practice Address - Phone:770-925-2010
Practice Address - Fax:770-925-1665
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004525363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA853231242AMedicaid
GA853231242AMedicaid