Provider Demographics
NPI:1104806801
Name:FIER, NICOLE BAKKER (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BAKKER
Last Name:FIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 ELIZABETH ST NE
Mailing Address - Street 2:STE A-112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1967
Mailing Address - Country:US
Mailing Address - Phone:770-507-0005
Mailing Address - Fax:770-507-5551
Practice Address - Street 1:280 ELIZABETH ST NE
Practice Address - Street 2:STE A-112
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1967
Practice Address - Country:US
Practice Address - Phone:770-507-0005
Practice Address - Fax:770-507-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0452172084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H00683Medicare UPIN
26BDGWPMedicare ID - Type Unspecified