Provider Demographics
NPI:1881215499
Name:GOBER, NICOLE (CEO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GOBER
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PRADA CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8007
Mailing Address - Country:US
Mailing Address - Phone:770-545-0415
Mailing Address - Fax:678-550-6426
Practice Address - Street 1:703 PRADA CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8007
Practice Address - Country:US
Practice Address - Phone:770-545-0415
Practice Address - Fax:678-550-6426
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver