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General NPI Number Information
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NPI Number | 1295974988
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Entity Type | Individual
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Provider Name | ANTONE M NICHOLS D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 1723 UNIVERSITY AVE STE B
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City | OXFORD
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State | MS
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Zip | 38655-4109
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Country | US
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Telephone | 662-290-9091
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Fax |
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Provider Business Mailing Address
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Address Line | 1723 UNIVERSITY AVE STE B BOX 315
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 662-290-9091
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Fax |
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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 | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 21627
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 21627
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License Number State | MS
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