Provider Demographics
NPI:1376637314
Name:NICHOLSON, ROMERO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMERO
Middle Name:
Last Name:NICHOLSON
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 1:1355 CHURCH STREET EXT NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1355 CHURCH STREET EXT NE
Practice Address - Street 2:SUITE F
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1099
Practice Address - Country:US
Practice Address - Phone:770-499-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30844207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000374624CMedicaid
GAE22645Medicare UPIN