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General NPI Number Information
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NPI Number | 1578596615
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Entity Type | Individual
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Provider Name | STEPHEN A NICKISCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 2060 DAN PROCTOR DR SUITE 1200
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City | SAINT MARYS
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State | GA
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Zip | 31558-3894
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Country | US
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Telephone | 912-540-6750
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Fax | 912-540-6773
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Provider Business Mailing Address
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Address Line | 2060 DAN PROCTOR DR STE 1200
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City | SAINT MARYS
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State | GA
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Zip | 31558-3895
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Country | US
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Telephone | 912-540-6750
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Fax | 912-540-6773
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 10278
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License Number State | MT
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