Provider Demographics
NPI:1558781179
Name:NICHOLS, GEORGINA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SCRIPPS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6378
Mailing Address - Country:US
Mailing Address - Phone:916-929-1833
Mailing Address - Fax:916-929-6730
Practice Address - Street 1:95 SCRIPPS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6378
Practice Address - Country:US
Practice Address - Phone:916-929-1833
Practice Address - Fax:916-929-6730
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38436390200000X
CA175636208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program