Provider Demographics
NPI:1609898022
Name:NICHOLAS, PAUL GEORGE III (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GEORGE
Last Name:NICHOLAS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 304
Mailing Address - Street 2:24 EAST AVE
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098
Mailing Address - Country:US
Mailing Address - Phone:856-769-0900
Mailing Address - Fax:856-769-2639
Practice Address - Street 1:24 EAST AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1409
Practice Address - Country:US
Practice Address - Phone:856-769-0900
Practice Address - Fax:856-769-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB40789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine