Provider Demographics
NPI:1467452771
Name:NICHOLS, JOHN KEITH (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEITH
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:KEITH
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2700 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1717
Mailing Address - Country:US
Mailing Address - Phone:423-417-1700
Mailing Address - Fax:866-719-8717
Practice Address - Street 1:2700 OAK ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1717
Practice Address - Country:US
Practice Address - Phone:423-717-1700
Practice Address - Fax:866-719-8717
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29413207X00000X, 208100000X
TN29413208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3811739Medicare ID - Type Unspecified
TNF64810Medicare UPIN
TN0406260001Medicare NSC