Healthcare Provider Details

I. General information

NPI: 1114924966
Provider Name (Legal Business Name): JAMES WILLIAM NICHOL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIM WILLIAM NICHOL

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 EAST MAIN ST
GRASS VALLEY CA
95945
US

IV. Provider business mailing address

1350 EAST MAIN ST
GRASS VALLEY CA
95945
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-8545
  • Fax: 530-477-7177
Mailing address:
  • Phone: 530-477-8545
  • Fax: 530-477-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number40830
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13474
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: