MEDICARE: NICHOLAS DUQUETTE MAYFIELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	060668	GA
2	207W00000X	Ophthalmology Physician	060668	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467479089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS DUQUETTE MAYFIELD MD

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-3035
Country	:	US
Telephone Number	:	706-323-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5323
Country	:	US
Telephone Number	:	706-323-3491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/28/2024

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