Provider Demographics
NPI:1336394675
Name:ZEMKOV, NELLY S (CSA)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:S
Last Name:ZEMKOV
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 N POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4248
Mailing Address - Country:US
Mailing Address - Phone:770-559-8725
Mailing Address - Fax:770-559-8276
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:BUILDING 200 STE 207
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4248
Practice Address - Country:US
Practice Address - Phone:770-559-8725
Practice Address - Fax:770-559-8276
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3295246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant