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General NPI Number Information
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NPI Number | 1154635159
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Entity Type | Individual
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Provider Name | MARGARET ELLZEY-NICHOLS D.M.D
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Gender | Female
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 1212 MISSION 66
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City | VICKSBURG
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State | MS
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Zip | 39183-3137
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Country | US
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Telephone | 601-636-5321
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Fax | 601-636-5321
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Provider Business Mailing Address
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Address Line | 133 KENZIE DRIVE
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City | MADISON
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State | MS
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Zip | 39110-4519
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Country | US
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Telephone | 601-270-7903
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Fax | 601-883-2366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3559-10
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License Number State | MS
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