Individual
DR. WILLIAM CLYDE NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF ENDOCRINOLOGY, JACKSON, MS 39216-4500
(601) 984-5525
Mailing address
PO BOX 24146, UNIVERSITY PHYSICIANS PLLC, JACKSON, MS 39225-4146
(601) 984-5525
(601) 984-5769
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
08290
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017122
—
MS
05
—
1960802
—
LA
01
—
RR 110127661
RAILROAD
MS
Enumeration date
07/20/2006
Last updated
06/14/2012
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