Organization
325 MDG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE NICHOLAS JR. (325 MDG COMMANDER)
(850) 283-7515
Entity
Organization
Contact information
Practice address
325 MDG BLDG, 1305 SUWANNEE AVE, TYNDALL AFB, FL 32403
(850) 283-7511
(850) 283-7721
Mailing address
2405 MAPLE CT, PANAMA CITY, FL 32404-3047
(850) 283-7511
(850) 283-7721
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY5848
FL
Other
Enumeration date
02/14/2006
Last updated
06/13/2008
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