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Individual

DR. JEROME TAK NICHOLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 510-6200
(540) 857-5306
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713

Taxonomy

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

Other

Enumeration date
07/06/2007
Last updated
04/13/2023
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