Nicole Mayberry O'Donnell, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

8103 Issued in GA

Practice address

5445 Meridian Mark Rd Ste 250
Atlanta, GA 30342-4767

Phone

(404) 255-1933

Fax

(404) 256-7924

NPI assigned

Aug 17, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tenet Florida Physician Services II, LLC

  • Orthopaedic Surgery Physician
  • West Palm Beach, FL
  • NPI 1912266420
  Medicare reassignment
• Children'S Orthopaedics of Atlanta P.C.

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1548247000
  NPD
• Tenet Florida Physician Services II, LLC

  • Durable Medical Equipment & Medical Supplies
  • Boca Raton, FL
  • NPI 1770391286
  NPD
• Tenet Florida Physician Services LLC

  • Surgery Physician
  • West Palm Beach, FL
  • NPI 1659417467
  NPD
• Choa Hospital Based, LLC

  • Pediatrics Physician
  • Brookhaven, GA
  • NPI 1457695488
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1093260226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARK RD STE 250",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424767",
            "telephone_number": "404-255-1933",
            "fax_number": "404-256-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARK RD STE 250",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424767",
            "telephone_number": "404-255-1933",
            "fax_number": "404-256-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "NICOLE",
        "middle_name": "MAYBERRY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-17",
        "last_updated": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "8103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "5445 Meridian Mark Rd Ste 250",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303424767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Leah Faye Matalon O'Callaghan, C-AA
• Jillian O'Connell
• John O'Connell, MD
• Patrick O'Connell
• Christopher O'Donnell, M.D.
• Emily Ann O'Gorman
• Leigh Amerson O'Guin, NP
• Kristin Nicole O'Guinn, BCBA
• Amber O'Hara
• Danielle Pilling O'Haren, P.A.

• Surgical Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.