Individual
DR. MICHAEL R NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
266 KATHERINE DR, JACKSON, MS 39232-8801
(601) 420-3223
(601) 420-3054
Mailing address
266 KATHERINE DR, JACKSON, MS 39232-8801
(601) 420-3223
(601) 420-3054
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3119-00
MS
174400000X
Specialist
Primary
OS-340-00
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00213548
—
MS
Enumeration date
03/07/2007
Last updated
09/11/2025
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