Nicole Gober, CEO
Individual provider Active NPI Driver · Lawrenceville, GA
NPI 1881215499 · NPPES record last updated May 5, 2020
Key facts
- NPI
- 1881215499
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 703 Prada CT
Lawrenceville, GA 30043-8007 - Phone
- (770) 545-0415
- Fax
- (678) 550-6426
- NPI assigned
- May 5, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
703 Prada CT
Lawrenceville, GA 30043-8007
Mailing address
703 Prada CT
Lawrenceville, GA 30043-8007
Phone (770) 545-0415
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.ay3sllc.com |
Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.