Nicole A Gurbal, O.D.

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

OPT002230 Issued in GA

Practice address

619 Dixie St
Carrollton, GA 30117-3816

Phone

(770) 834-0212

Fax

(770) 834-0213

NPI assigned

Sep 14, 2005

Last updated

Oct 4, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1588659692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173816",
            "telephone_number": "770-834-0212",
            "fax_number": "770-834-0213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173816",
            "telephone_number": "770-834-0212",
            "fax_number": "770-834-0213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GURBAL",
        "first_name": "NICOLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-14",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002230",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "GA",
            "license": "OPT002230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Allison Griffin, CRNP
• Jill Megan Grilliot, MD
• Tracy R Grissett, P.T
• DL Griswold
• Joshua William Theodore Grubb, LPC
• L Mark Gustafson, M.D.
• Austin Haedicke, LPC, CPCS, CCC, PN1
• Holley V. Hagan, NP-C
• Kristi Haisler, PMHNP
• Brett Alexander Hall, FNP

• Pediatric Optometrist in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Pediatric Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.