Provider Demographics
NPI:1508802778
Name:NICHOLS, HAROLD A (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
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:PO BOX 26580
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-6580
Mailing Address - Country:US
Mailing Address - Phone:336-832-8014
Mailing Address - Fax:
Practice Address - Street 1:509D N ELAM AVE
Practice Address - Street 2:NORTH ELAM MEDICAL PLAZA
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1118
Practice Address - Country:US
Practice Address - Phone:336-832-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22315208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8962541Medicaid
NC8962541Medicaid
C81877Medicare UPIN