Provider Demographics
NPI:1316021082
Name:SALVO, NICHOL LYNN (DPM)
Entity Type:Individual
Prefix:
First Name:NICHOL
Middle Name:LYNN
Last Name:SALVO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MULKEY ROAD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:770-941-3633
Mailing Address - Fax:770-944-9038
Practice Address - Street 1:2550 WINDY HILL ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:770-952-2040
Practice Address - Fax:770-988-0379
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001040213E00000X
GAPOD001040213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
511-480017Medicare PIN
GA0628010001Medicare NSC