Provider Demographics
NPI:1316593262
Name:METTE, NICOLE THERESIA (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESIA
Last Name:METTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-2803
Mailing Address - Country:US
Mailing Address - Phone:229-225-1900
Mailing Address - Fax:
Practice Address - Street 1:119 W HILL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-2803
Practice Address - Country:US
Practice Address - Phone:229-225-1900
Practice Address - Fax:229-225-3455
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12149207R00000X
390200000X
GA95524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program