Provider Demographics
NPI:1174557359
Name:SETKA, NATHAN MILAN
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:MILAN
Last Name:SETKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PEACHTREE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9762
Mailing Address - Country:US
Mailing Address - Phone:678-513-5260
Mailing Address - Fax:678-513-5261
Practice Address - Street 1:610 PEACHTREE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9762
Practice Address - Country:US
Practice Address - Phone:678-513-5260
Practice Address - Fax:678-513-5261
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1071719363A00000X
GA9219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN