MEDICARE: ROBERT L NICHOLAS, 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	2084P0800X	Psychiatry Physician	21422	GA

General Provider Information

NPI Number	:	1568594141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L NICHOLAS, MD

Provider Business Mailing Address
First Line	:	1790 CENTURY BLVD NE
Second Line	:	SUITE A
City	:	ATLANTA
State	:	GA
Zip	:	30345-3322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1790 CENTURY BLVD NE
Second Line	:	SUITE A
City	:	ATLANTA
State	:	GA
Zip	:	30345-3322
Country	:	US
Telephone Number	:	404-636-1444
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT L NICHOLAS
Credential	:	M.D.
Telephone Number	:	404-636-1444

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	08/22/2020

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