Healthcare Provider Details

I. General information

NPI: 1063157634
Provider Name (Legal Business Name): NICHOLAS GEORGELOS, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PHYSICIANS WAY
FRANKLIN TN
37067-1471
US

IV. Provider business mailing address

PO BOX 331244
NASHVILLE TN
37203-7512
US

V. Phone/Fax

Practice location:
  • Phone: 615-721-4000
  • Fax:
Mailing address:
  • Phone: 630-913-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GEORGELOS
Title or Position: PRESIDENT
Credential: DO
Phone: 630-913-9072