Individual
BRADY WILSON NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1920 W 1ST ST, WINSTON SALEM, NC 27104-4220
(336) 716-4479
Mailing address
119 CLUBHOUSE DR, WEST COLUMBIA, SC 29172-2587
(843) 816-1974
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2022-01793
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2019
Last updated
10/13/2023
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