Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101013259 | MI |
NPI | 1154439586 |
---|---|
Provider Name | Dr. Barbara D Nichols |
First Address | Newnan, GA 30265-4136 |
Second Address | Atlanta, GA 30309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114759640 | (05) | MI |
BN013259 | BC/BS OF MICHIGAN (01) | MI |
G63643 | (02) | MI |