Provider Demographics
NPI:1740398916
Name:NICHOLS, MARGARET MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:MARY
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8637
Mailing Address - Country:US
Mailing Address - Phone:478-741-1776
Mailing Address - Fax:478-741-1775
Practice Address - Street 1:1062 FORSYTH ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8637
Practice Address - Country:US
Practice Address - Phone:478-741-1776
Practice Address - Fax:478-741-1775
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00721223DMedicaid
GA2133462OtherAETNA
GA52598399-001OtherBLUE CROSS BLUE SHIELD
GA8286141-002OtherCIGNA
GA8286141-002OtherCIGNA
GA00721223DMedicaid