Healthcare Provider Details

I. General information

NPI: 1194257634
Provider Name (Legal Business Name): NICHOLAS JOHN ERICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 10/31/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD EAST STE 702
TUSCALOOSA AL
35401
US

IV. Provider business mailing address

3901 GREENBORO AVE STE A
TUSCALOOSA AL
35405
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-7561
  • Fax: 205-759-7022
Mailing address:
  • Phone: 205-333-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.37665
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: