NICOLE MAYBERRY O'DONNELL PA-C
NPI 1093260226
Physician Assistant - Surgical in Atlanta, GA

Q: What is Nicole O'donnell's NPI number?

The NPI number for Nicole O'donnell is 1093260226. It was assigned to this individual provider in the NPPES registry on August 17, 2016.

Q: What is Nicole O'donnell's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Nicole O'donnell was last updated on June 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 17, 2016PECOS Enrolled

5445 MERIDIAN MARK RD STE 250, ATLANTA, GA 30342(404) 255-1933(404) 256-7924 Get Directions Write a Review

NPPES record last updated: June 6, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 6, 2022, Jun 25, 2021, Mar 17, 2018 and 2 more (5 updates tracked since 2016).

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About Nicole Mayberry O'donnell Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE MAYBERRY O'DONNELL PA-C (NPI 1093260226) is an individual surgical provider in Atlanta, Georgia, licensed in Georgia (8103) and active in the NPI registry since August 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1093260226

Entity TypeIndividualFemale

Primary Taxonomy363AS0400X

Provider Legal NameNICOLE MAYBERRY O'DONNELLCredential: PA-C

Location Address5445 MERIDIAN MARK RD STE 250Atlanta, GA 30342-4767

Mailing Address5445 Meridian Mark Rd Ste 250Atlanta, GA 30342-4767 · (404) 255-1933 · Fax (404) 256-7924

Phone(404) 255-1933

Fax(404) 256-7924

Sole ProprietorNo

Enumeration DateAugust 17, 2016

Last NPPES UpdateJune 6, 20225 updates tracked since enumeration

✔ NPI 1093260226 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in GA · 8103

5445 MERIDIAN MARK RD STE 250, Atlanta, GA 30342

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Mayberry O'donnell Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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