Provider Demographics
NPI:1053575480
Name:NIKOLSKY, VICTOR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:NIKOLSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 S HAIRSTON RD STE 28
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2719
Mailing Address - Country:US
Mailing Address - Phone:404-292-9034
Mailing Address - Fax:404-292-9037
Practice Address - Street 1:385 S SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:NY
Practice Address - Zip Code:12134-5917
Practice Address - Country:US
Practice Address - Phone:518-883-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71777207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine