Provider Demographics
NPI:1609025790
Name:NICHOLSON, DANIEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALAN
Last Name:NICHOLSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 825
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-255-5595
Mailing Address - Fax:404-252-2780
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 825
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-255-5595
Practice Address - Fax:404-252-2780
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2012-06-26
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Provider Licenses
StateLicense IDTaxonomies
GA68081207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine