Provider Demographics
NPI:1376895946
Name:KONGOASA, NICHOLAS (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KONGOASA
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 HOLCOMB BRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5244
Mailing Address - Country:US
Mailing Address - Phone:770-450-8677
Mailing Address - Fax:
Practice Address - Street 1:3965 HOLCOMB BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2203
Practice Address - Country:US
Practice Address - Phone:770-450-8677
Practice Address - Fax:678-792-8927
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68445207V00000X, 207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology