Individual
WILLIAM J NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
(717) 851-2441
Mailing address
1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
(717) 851-2441
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD428324
PA
207RI0011X
Interventional Cardiology Physician
Primary
51365
GA
207RI0011X
Interventional Cardiology Physician
MD428324
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101672879
—
PA
01
—
1877187
HIGHMARK BLUE SHIELD
PA
01
—
50065666
CAPITAL BLUE CROSS
PA
01
—
P00418739
RAILROAD MEDICARE PIN
PA
Enumeration date
06/13/2006
Last updated
09/26/2022
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