Provider Demographics
NPI:1467113050
Name:CALL, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 OLD TROLLEY RD # 105
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4951
Mailing Address - Country:US
Mailing Address - Phone:843-371-5433
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:905 DUKES ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2059
Practice Address - Country:US
Practice Address - Phone:843-563-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant