Individual
MATTHEW STEVEN NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-2643
(706) 721-8623
(706) 721-1459
Mailing address
PO BOX 1705, AUGUSTA, GA 30903-1705
(706) 774-7263
(706) 774-7230
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
072981
GA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
72981
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318962
—
SC
Enumeration date
06/18/2009
Last updated
08/06/2021
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