Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 66230 | GA |
NPI | 1053571810 |
---|---|
Provider Name | Dr. Robert Sheppard Nickel |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2008 |
Last Update Date | 12/06/2014 |