Provider Demographics
NPI:1306658596
Name:RAIFORD, NIKKIA
Entity type:Individual
Prefix:
First Name:NIKKIA
Middle Name:
Last Name:RAIFORD
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 1:4879 EMBARCADERO LN APT 28-12
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6513
Mailing Address - Country:US
Mailing Address - Phone:470-895-2146
Mailing Address - Fax:
Practice Address - Street 1:101 BECKETT LN STE 303
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7158
Practice Address - Country:US
Practice Address - Phone:470-895-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty