Healthcare Provider Details

I. General information

NPI: 1629669585
Provider Name (Legal Business Name): NICHOLAS WILLIAM EYRICH MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 JESSE JEWELL PKWY SE STE 200
GAINESVILLE GA
30501-3861
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-8438
  • Fax:
Mailing address:
  • Phone: 770-848-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number114287
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: