Provider Demographics
NPI:1548394653
Name:NICHOLS, PAMELA JO (CNMT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JO
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 ALPS RD STE 2 PMB 248
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4098
Mailing Address - Country:US
Mailing Address - Phone:770-317-6959
Mailing Address - Fax:706-795-3213
Practice Address - Street 1:2350 PRINCE AVE
Practice Address - Street 2:STE 5
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6031
Practice Address - Country:US
Practice Address - Phone:770-317-6959
Practice Address - Fax:705-795-3213
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist