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General NPI Number Information
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NPI Number | 1407376650
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Entity Type | Individual
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Provider Name | KENDALL JAMES NICHOLS MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 12 EXECUTIVE PARK DR NE FL 4
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City | ATLANTA
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State | GA
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Zip | 30329-2206
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Country | US
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Telephone | 404-712-7533
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Fax |
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Provider Business Mailing Address
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Address Line | 420 DELAWARE STREET SE MMC 295, DEPARTMENT OF NEUROLOGY
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone |
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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 | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 97548
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License Number State | GA
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