Provider Demographics
NPI:1639848930
Name:JAMES WILSON, NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JAMES WILSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 BRANDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5341
Mailing Address - Country:US
Mailing Address - Phone:281-543-5015
Mailing Address - Fax:
Practice Address - Street 1:1736 BRANDEMERE DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168
Practice Address - Country:US
Practice Address - Phone:404-919-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor