# DR. JEROME TAK NICHOLS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1386842763
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 070145 | GA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 0101261482 | VA | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | TP934 | KY | — |

## Other

- **Enumeration date:** 07/06/2007
- **Last updated:** 04/13/2023