Individual
NICKOLOZ TCHANKOSHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 E MAIN ST, LEESBURG, FL 34748-5399
(352) 728-3898
(352) 728-6240
Mailing address
PO BOX 44008, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME120378
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003150531A
—
GA
05
—
012796400
—
FL
Enumeration date
07/19/2010
Last updated
12/04/2018
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