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General NPI Number Information
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NPI Number | 1861624330
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Entity Type | Organization
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Legal Business Name | SCOTT R. NICHOLS M.D. P.A.
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 3801 CAMDEN RD # 22
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City | PINE BLUFF
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State | AR
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Zip | 71603-4612
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Country | US
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Telephone | 870-879-3517
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 CAMDEN RD # 22
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City | PINE BLUFF
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State | AR
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Zip | 71603-4612
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Country | US
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Telephone | 870-879-3517
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT R NICHOLS
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Credential | MD
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Telephone | 870-879-3517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C6461
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License Number State | AR
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