Provider Demographics
NPI:1427468685
Name:NICHOLS, ANGELA (PTA)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:VEATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1156 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-3805
Mailing Address - Country:US
Mailing Address - Phone:706-597-1190
Mailing Address - Fax:706-597-1191
Practice Address - Street 1:1043 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7318
Practice Address - Country:US
Practice Address - Phone:706-597-1190
Practice Address - Fax:706-597-1191
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000561225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant