Provider Demographics
NPI:1356946263
Name:GUO, NINA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 OAKBROOK LAKE CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1757
Mailing Address - Country:US
Mailing Address - Phone:843-424-6629
Mailing Address - Fax:
Practice Address - Street 1:2700 NORTHEAST EXPY NE STE B800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1828
Practice Address - Country:US
Practice Address - Phone:404-367-9111
Practice Address - Fax:404-367-9199
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist