Healthcare Provider Details

I. General information

NPI: 1437316114
Provider Name (Legal Business Name): KATHERINE ELIZABETH NICHOLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE SCOTTISH RITE CHILDREN'S HOSPITAL EMERGENCY DEPARTMENT
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD NE SCOTTISH RITE CHILDREN'S HOSPITAL EMERGENCY DEPARTMENT
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-1960
  • Fax: 678-344-1960
Mailing address:
  • Phone: 678-344-1960
  • Fax: 678-344-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number63930
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: