Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 85394 | GA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | ME151039 | FL |
NPI | 1194111963 |
---|---|
Provider Name | Christopher James Nickel |
First Address | Atlanta, GA 30308-2234 |
Second Address | Atlanta, GA 30308-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
YH196 | BCBS (01) | FL |