Individual
RANDALL WAYNE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2431 W MAIN ST, SUITE 1001, DOTHAN, AL 36301-1217
(334) 677-6220
(334) 677-2206
Mailing address
PO BOX 6188, DOTHAN, AL 36302-6188
(334) 677-6220
(334) 677-2206
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9258
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00296557C
—
GA
05
—
069046500
—
FL
01
—
51083586
BLUE CROSS BLUE SHIELD
AL
05
—
529906170
—
AL
Enumeration date
10/10/2006
Last updated
05/08/2017
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