Healthcare Provider Details

I. General information

NPI: 1154439586
Provider Name (Legal Business Name): BARBARA D NICHOLS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD. NORTHEAST
ATLANTA GA
30309
US

IV. Provider business mailing address

277 SKY VIEW CT
NEWNAN GA
30265-4136
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-3297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101013259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: