Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 11499 | TN |
NPI | 1053697813 |
---|---|
Provider Name | Amy G Nicholson |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 21/10/2020 |