Provider Demographics
NPI:1265546782
Name:SUDANO, NICHOLAS J (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:SUDANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 SHALLOWFORD RD STE 142
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3175
Mailing Address - Country:US
Mailing Address - Phone:770-552-7009
Mailing Address - Fax:770-587-9877
Practice Address - Street 1:4401 SHALLOWFORD RD STE 142
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3175
Practice Address - Country:US
Practice Address - Phone:770-552-7009
Practice Address - Fax:770-587-9877
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0027833OtherPIN #
GA35ZCCKJMedicare ID - Type Unspecified