Individual
DR. WILLIAM PATRICK NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
970 LAKELAND DR STE 61, JACKSON, MS 39216-4682
(601) 982-7850
Mailing address
970 LAKELAND DR STE 61, JACKSON, MS 39216-4682
(601) 982-7850
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
25101
MS
207RI0011X
Interventional Cardiology Physician
Primary
25101
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09872218
—
MS
01
—
1Q4772
MEDICARE ST DOM
MS
01
—
25101
MS MED LIC
MS
05
—
8855561
—
MS
Enumeration date
05/26/2014
Last updated
11/15/2023
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