Basic Information
| Provider Information | |||||||||
| NPI: | 1376586248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANTS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 SW 78TH AVE | ||||||||
| Address2: | SUITE 100B | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
| FaxNumber: | 9546256034 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 E MCPHERSON AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316392326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295437100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 02/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 055164 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00229776 | 01 | GA | RAILROAD MEDICARE | OTHER | 009976565 | 05 | AL | MEDICAID | 725573514A | 05 | GA | MEDICAID |