Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000359 | TN |
NPI | 1295755528 |
---|---|
Provider Name | Dr. Berkeley H Nicholls |
First Address | Nashville, TN 37203-7501 |
Second Address | Nashville, TN 37203-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 27/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3351581 | (05) | TN |
T51502 | (02) | TN |