Provider Demographics
NPI:1376586248
Name:MCCANTS, NICOLE L (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:MCCANTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 SW 78TH AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3273
Mailing Address - Country:US
Mailing Address - Phone:877-693-5700
Mailing Address - Fax:954-625-6034
Practice Address - Street 1:1221 E MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2326
Practice Address - Country:US
Practice Address - Phone:229-543-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055164207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00229776OtherRAILROAD MEDICARE
AL009976565Medicaid
GA725573514AMedicaid
AL009976565Medicaid
GAP00229776OtherRAILROAD MEDICARE