Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 021423 | GA |
NPI | 1003816166 |
---|---|
Provider Name | Dr. F. Peter Nicholson |
First Address | Mcdonough, GA 30253-4310 |
Second Address | Monroe, GA 30655-3196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000217104F | (05) | GA |
D30351 | (02) | GA |