Individual
DR. NICKSON HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3564 HIGHWAY 138 SE, STOCKBRIDGE, GA 30281-4170
(770) 474-5617
(770) 474-6576
Mailing address
3564 HIGHWAY 138 SE, STOCKBRIDGE, GA 30281-4170
(770) 474-5617
(770) 474-6576
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2263
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
238123293B
—
GA
Enumeration date
06/26/2006
Last updated
09/03/2014
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