Provider Demographics
NPI:1053409094
Name:NICHOLS, JOSEPH J JR (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:J
Other - Last Name:NICHOLS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 475
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-351-7900
Mailing Address - Fax:404-351-7901
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 475
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-351-7900
Practice Address - Fax:404-351-7901
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35712208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
28BBBBBMedicare PIN
GAF33264Medicare UPIN
GA28BBBBBMedicare PIN