Provider Demographics
NPI:1114004983
Name:NICHOLS, DARYL LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:LEWIS
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 CHURCH STREET
Mailing Address - Street 2:SUITE 506
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-329-7905
Mailing Address - Fax:615-284-6515
Practice Address - Street 1:2021 CHURCH STREET
Practice Address - Street 2:#506
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-7905
Practice Address - Fax:615-284-6515
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000011717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B04313Medicare UPIN
3188048Medicare ID - Type Unspecified