Provider Demographics
NPI:1700631819
Name:WOODS, NICOLE NICHELLE (PHD, DNM, LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NICHELLE
Last Name:WOODS
Suffix:
Gender:F
Credentials:PHD, DNM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 CARRIAGE HOUSE CT APT B
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6370
Mailing Address - Country:US
Mailing Address - Phone:404-822-9119
Mailing Address - Fax:
Practice Address - Street 1:3939 CARRIAGE HOUSE CT APT B
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6370
Practice Address - Country:US
Practice Address - Phone:404-822-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011346225700000X
FLMA96882225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist