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1194111963

NPI Code Detail

MEDICARE: CHRISTOPHER JAMES NICKEL MD

MEDICARE: CHRISTOPHER JAMES NICKEL MD

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	207Y00000X	Otolaryngology Physician	85394	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	ME151039	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YH196	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194111963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JAMES NICKEL MD

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE STE 1135
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2234
Country	:	US
Telephone Number	:	404-778-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1135
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2234
Country	:	US
Telephone Number	:	404-778-3381
Fax Number	:

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

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	08/12/2021

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Directions to “ CHRISTOPHER JAMES NICKEL MD” Practice Location

Language	Start Address	Practice Location

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