Active NPI
Kim Richard Nicola, M.D.
- Specialist
- Kennesaw, GA
National Provider Identifier
1770608267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 027881
- Practice address
- 2928 Busbee Pkwy NW
530
Kennesaw, GA 30144-4820 - Phone
- (770) 627-4950
- Fax
- (770) 627-4950
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 027881 | GA | Primary |
Addresses
Primary practice location
2928 Busbee Pkwy NW
530
Kennesaw, GA 30144-4820
Mailing address
2928 Busbee Pkwy NW
530
Kennesaw, GA 30144-4820
Phone (770) 627-4950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00312375D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| GBM Enterprises, Inc. | Past | Accepting new patients |
Interoperability endpoints
- kim.nicola@westgahealth.gadirect.net
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200355200000",
"number": "1770608267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2928 BUSBEE PKWY NW",
"address_2": "530",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301444820",
"telephone_number": "770-627-4950",
"fax_number": "770-627-4950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2928 BUSBEE PKWY NW",
"address_2": "530",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301444820",
"telephone_number": "770-627-4950",
"fax_number": "770-627-4950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLA",
"first_name": "KIM",
"middle_name": "RICHARD",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2008-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "027881",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00312375D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.