Provider Demographics
NPI:1427210475
Name:NICHOLSON, KIMBERLY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 STONEFOREST DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4880
Mailing Address - Country:US
Mailing Address - Phone:770-516-5199
Mailing Address - Fax:770-516-5199
Practice Address - Street 1:100 STONEFOREST DR
Practice Address - Street 2:SUITE 320
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4880
Practice Address - Country:US
Practice Address - Phone:770-516-5199
Practice Address - Fax:770-516-5199
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA68082207N00000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology