Individual
DR. JEFFREY M NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
631 PROFESSIONAL DR, SUITE 120, LAWRENCEVILLE, GA 30046-3367
(678) 312-3290
(678) 312-2733
Mailing address
631 PROFESSIONAL DR STE 120, LAWRENCEVILLE, GA 30046-3370
(678) 312-3290
(678) 312-2733
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
048377
GA
2086S0102X
Surgical Critical Care Physician
Primary
048377
GA
2086S0127X
Trauma Surgery Physician
048377
GA
Other
Enumeration date
10/20/2006
Last updated
11/03/2020
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