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Individual

AUBREY NORWOOD NICHOLS III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
414B MARION AVE, MCCOMB, MS 39648-2710
(601) 684-3112
(601) 249-3290
Mailing address
414B MARION AVE, MCCOMB, MS 39648-2710
(601) 684-3112
(601) 249-3290

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
07694
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00119350
MS
01
07694
STATE LICENSE
MS
01
1346385762
CIGNA
01
5875836375A
BLUE CROSS BLUE SHIELD - ALL
MS
Enumeration date
01/10/2007
Last updated
01/14/2011
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