Provider Demographics
NPI:1083655104
Name:NICHOLLS, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:NICHOLLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 890437
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0437
Mailing Address - Country:US
Mailing Address - Phone:859-278-3481
Mailing Address - Fax:859-277-7365
Practice Address - Street 1:1780 NICHOLASVILLE ROAD
Practice Address - Street 2:SUITE 501
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-3481
Practice Address - Fax:859-277-7365
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20294207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047276OtherBCBS NUMBER
KY64202948Medicaid
KY5930050OtherAETNA
KY64202948Medicaid
KY1207905Medicare PIN