Provider Demographics
NPI:1447787510
Name:VERNOLA, NICHOLAS JR (PT, DPT, SDN)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:VERNOLA
Suffix:JR
Gender:M
Credentials:PT, DPT, SDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 HILLCREST AVE APT E
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:966 KILLIAN HILL RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3102
Practice Address - Country:US
Practice Address - Phone:770-923-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041192-1225100000X
GAPT012845225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist