Provider Demographics
NPI:1275174245
Name:NESBITT, DERRICK ANTONIE
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:ANTONIE
Last Name:NESBITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DERRICK
Other - Middle Name:
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRANSPORTATION
Mailing Address - Street 1:360 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3434
Mailing Address - Country:US
Mailing Address - Phone:678-350-8489
Mailing Address - Fax:
Practice Address - Street 1:360 FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3434
Practice Address - Country:US
Practice Address - Phone:678-350-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver