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General NPI Number Information
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NPI Number | 1801823745
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Entity Type | Individual
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Provider Name | JOHN ALEXANDER NICHOLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 606 BLACK RIVER RD STE 101
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City | GEORGETOWN
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State | SC
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Zip | 29440-3304
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Country | US
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Telephone | 843-545-5927
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Fax | 843-520-4780
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Provider Business Mailing Address
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Address Line | PO BOX 421718
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City | GEORGETOWN
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State | SC
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Zip | 29442-4203
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Country | US
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Telephone | 843-527-7000
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | SC 15656
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | SC 15656
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License Number State | SC
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