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General NPI Number Information
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NPI Number | 1760738199
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Entity Type | Organization
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Legal Business Name | SHOALS ORTHOPEDICS AND SPORTS MEDICINE
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 203 AVALON AVE SUITE 230
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City | MUSCLE SHOALS
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State | AL
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Zip | 35661-2869
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Country | US
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Telephone | 256-718-4041
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Fax | 256-718-3665
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Provider Business Mailing Address
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Address Line | 426 W COLLEGE ST
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City | FLORENCE
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State | AL
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Zip | 35630-5521
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Country | US
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Telephone | 256-718-4041
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Fax | 256-718-3665
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEE NICHOLS JR.
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Credential | M.D.
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Telephone | 256-718-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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