Provider Demographics
NPI:1538102041
Name:NICHOLSON, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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 1:4211 JOE RAMSEY BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7856
Mailing Address - Country:US
Mailing Address - Phone:903-408-4767
Mailing Address - Fax:903-408-7704
Practice Address - Street 1:4501 JOE RAMSEY BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7843
Practice Address - Country:US
Practice Address - Phone:903-408-5800
Practice Address - Fax:903-455-8232
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX807193OtherBLUE CROSS BLUE SHIELD
TX099830402Medicaid
TX807193Medicare PIN