Provider Demographics
NPI:1528025855
Name:NICHOLLS, CHRISTOPHER E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:NICHOLLS
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 1:4300 WEST MAIN ST
Mailing Address - Street 2:STE 31
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4300
Mailing Address - Country:US
Mailing Address - Phone:334-793-6511
Mailing Address - Fax:334-677-5642
Practice Address - Street 1:4300 WEST MAIN ST
Practice Address - Street 2:WOMENS HEALTHCARE OF DOTHAN PC STE 31
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4300
Practice Address - Country:US
Practice Address - Phone:334-793-6511
Practice Address - Fax:334-677-5642
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938165Medicaid
AL051517147Medicare ID - Type Unspecified
H97461Medicare UPIN