Provider Demographics
NPI:1396330171
Name:MICOLE HEALTH SERVICES INC.
Entity type:Organization
Organization Name:MICOLE HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COLET
Authorized Official - Middle Name:IFEANYI
Authorized Official - Last Name:ODENIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:678-200-3363
Mailing Address - Street 1:4548 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6244
Mailing Address - Country:US
Mailing Address - Phone:678-200-3363
Mailing Address - Fax:
Practice Address - Street 1:4548 TULIP CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6244
Practice Address - Country:US
Practice Address - Phone:678-200-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty