MEDICARE: DR. DAWN W NICHOLS 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD0000037081	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1831159912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN W NICHOLS MD

Provider Business Mailing Address
First Line	:	939 E EMERALD AVE
Second Line	:	SUITE 705
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-524-2547
Fax Number	:	865-524-0224

Provider Business Practice Location Address
First Line	:	939 E EMERALD AVE
Second Line	:	SUITE 705
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-524-2547
Fax Number	:	865-524-0224

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/20/2010

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