Provider Demographics
NPI:1386083814
Name:ROSSI, NICHOLAS MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MATTHEW
Last Name:ROSSI
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:770-813-8888
Mailing Address - Fax:770-813-0007
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 470
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:770-813-8888
Practice Address - Fax:770-813-0007
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA006828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant