Healthcare Provider Details

I. General information

NPI: 1053409094
Provider Name (Legal Business Name): JOSEPH J NICHOLS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH J NICHOLS JR. M.D

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW SUITE 475
ATLANTA GA
30309
US

IV. Provider business mailing address

35 COLLIER RD NW SUITE 475
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-7900
  • Fax: 404-351-7901
Mailing address:
  • Phone: 404-351-7900
  • Fax: 404-351-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35712
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: