Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jeremiah Tate Nichols, PTA, LAT, ATC

Individual provider Athletic Trainer · NPI 1225784259

Jeremiah Tate Nichols, PTA, LAT, ATC is an Athletic Trainer in Canton, Georgia. Practices as a sole proprietor. Licensed in Georgia.

Licensed in
GA
In the registry since
2022
Specialties on file
2
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

147 Reinhardt College Pkwy Ste 9
Canton, GA 30114-5295
Phone: (770) 345-3057
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence PTA004362 (GA)
Athletic Trainer Taxonomy 2255A2300X · Licence AT002223 (GA)

Record details

NPI number1225784259
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA , LAT , ATC
Sole proprietorYes
NPI enumeratedFebruary 28, 2022
Last updated in NPPESFebruary 28, 2022
Certification dateFebruary 28, 2022

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