Provider Demographics
NPI:1629713235
Name:GABRIELLE, NICHOLAS DAVIS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DAVIS
Last Name:GABRIELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:DAVIS
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 NESTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8237
Mailing Address - Country:US
Mailing Address - Phone:770-841-4321
Mailing Address - Fax:
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:770-841-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program