# MR. JUSTIN DOYLE NICHOLSON

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

## Provider details

- **NPI number:** 1457806184
- **Gender:** Man
- **Credential:** NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | RN209728 | GA | Yes |
| 363LF0000X | Family Nurse Practitioner | RN209728 | GA | — |

## Other

- **Enumeration date:** 08/23/2016
- **Last updated:** 08/19/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003202905A | — | GA |
| 05 | — | 003202905B | — | GA |
| 01 | — | G00351A | MEDICARE PTAN | GA |