Individual
DR. AMANDA GRAY NICOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
501 MARSHALL STREET, SUITE 400, JACKSON, MS 39202-1687
(601) 354-0869
Mailing address
501 MARSHALL STREET, SUITE 400, JACKSON, MS 39202-1687
(601) 354-0869
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08221030
—
MS
Enumeration date
09/14/2007
Last updated
11/19/2011
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