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General NPI Number Information
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NPI Number | 1568594141
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Entity Type | Organization
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Legal Business Name | ROBERT L NICHOLAS, MD
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1790 CENTURY BLVD NE SUITE A
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City | ATLANTA
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State | GA
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Zip | 30345-3322
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Country | US
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Telephone | 404-636-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 1790 CENTURY BLVD NE SUITE A
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City | ATLANTA
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State | GA
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Zip | 30345-3322
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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 | OWNER
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Name | ROBERT L NICHOLAS
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Credential | M.D.
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Telephone | 404-636-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21422
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License Number State | GA
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