MEDICARE: T.M. NICHOLS LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	BL05-02072	GA

General Provider Information

NPI Number	:	1841246303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.M. NICHOLS LLC

Provider Business Mailing Address
First Line	:	5825 GLENRIDGE DR NE
Second Line	:	SUITE 1-112
City	:	ATLANTA
State	:	GA
Zip	:	30328-5387
Country	:	US
Telephone Number	:	404-847-9670
Fax Number	:	404-847-9669

Provider Business Practice Location Address
First Line	:	5825 GLENRIDGE DR NE
Second Line	:	SUITE 1-112
City	:	ATLANTA
State	:	GA
Zip	:	30328-5387
Country	:	US
Telephone Number	:	404-847-9670
Fax Number	:	404-847-9669

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MS. BERYL MARSH
Credential	:
Telephone Number	:	404-847-9670

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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