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General NPI Number Information
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NPI Number | 1386104685
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Entity Type | Organization
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Legal Business Name | NICHOLS OUTPATIENT FACIAL SURGERY
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 266 KATHERINE DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8801
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Country | US
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Telephone | 601-420-3223
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Fax | 601-420-3054
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Provider Business Mailing Address
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Address Line | 266 KATHERINE DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8801
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Country | US
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Telephone | 601-420-3223
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Fax | 601-420-3054
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R NICHOLS
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Credential | D.M.D, M.D.
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Telephone | 601-420-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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