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Individual

JULIE TIERNEY NICHOLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
203 WOODPARK PL STE 100, WOODSTOCK, GA 30188-3705
(770) 926-4150
(770) 926-0594
Mailing address
203 WOODPARK PL STE 100, WOODSTOCK, GA 30188-3705
(770) 926-4150
(770) 926-0594

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
87263
SC
207Q00000X
Family Medicine Physician
Primary
98300
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
872639
SC
Enumeration date
05/20/2014
Last updated
05/17/2024
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