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1902890908

NPI Code Detail

MEDICARE: GUY E NICHOLS MD

MEDICARE: GUY E NICHOLS 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD0000040155	TN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	0101046841	VA
3	207ZC0500X	Cytopathology Physician	0101046841	VA
4	207ZH0000X	Hematology (Pathology) Physician	0101046841	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	220021296	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	181665	OTHER	VA	ANTHEM-CENTERPOINT RD.
3	230531	OTHER	VA	ANTHEM-BREMO RD.
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902890908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY E NICHOLS MD

Provider Business Mailing Address
First Line	:	9303 PARK WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4397
Country	:	US
Telephone Number	:	865-373-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	9352 PARK WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4325
Country	:	US
Telephone Number	:	865-373-1000
Fax Number	:

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/02/2014

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1972543007 — DR. MICHAEL SHAWN MITCHELL M.D.
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Directions to “ GUY E NICHOLS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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