Provider Demographics
NPI:1174185060
Name:NICHOLS, ZEKE
Entity Type:Individual
Prefix:
First Name:ZEKE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10939 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1914
Mailing Address - Country:US
Mailing Address - Phone:256-522-2250
Mailing Address - Fax:
Practice Address - Street 1:10939 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1914
Practice Address - Country:US
Practice Address - Phone:256-522-2250
Practice Address - Fax:256-522-2251
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3823207Q00000X
AL44385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine