Provider Demographics
NPI:1184473936
Name:SCRUGGS, NICOLLE (MSC)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:PINE LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30072-0133
Mailing Address - Country:US
Mailing Address - Phone:919-624-0416
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 133
Practice Address - Street 2:
Practice Address - City:PINE LAKE
Practice Address - State:GA
Practice Address - Zip Code:30072-0133
Practice Address - Country:US
Practice Address - Phone:919-624-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist