Provider Demographics
NPI:1871307181
Name:NIFONG, SLONE SR (LMT)
Entity type:Individual
Prefix:MR
First Name:SLONE
Middle Name:
Last Name:NIFONG
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 APPLE ROSE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5757
Mailing Address - Country:US
Mailing Address - Phone:770-262-0458
Mailing Address - Fax:
Practice Address - Street 1:108 COLONY PARK DR STE 400-A
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2797
Practice Address - Country:US
Practice Address - Phone:678-978-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist