Provider Demographics
NPI:1649750688
Name:NEMORIN, ZOLA (MEDICAL ESTHETICIAN)
Entity Type:Individual
Prefix:MRS
First Name:ZOLA
Middle Name:
Last Name:NEMORIN
Suffix:
Gender:F
Credentials:MEDICAL ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 WOODTRACE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-4721
Mailing Address - Country:US
Mailing Address - Phone:678-447-6597
Mailing Address - Fax:
Practice Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD STE 165
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8490
Practice Address - Country:US
Practice Address - Phone:678-835-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAES004943207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology