MEDICARE: ANGEL NICHOLS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	13809	GA

General Provider Information

NPI Number	:	1013730597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL NICHOLS PA

Provider Business Mailing Address
First Line	:	1439 JESSE JEWELL PKWY NE STE 302
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3806
Country	:	US
Telephone Number	:	770-219-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1439 JESSE JEWELL PKWY NE STE 302
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3806
Country	:	US
Telephone Number	:	770-219-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	03/04/2026

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Directions to “ ANGEL NICHOLS PA” Practice Location

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