Provider Demographics
NPI:1922152503
Name:NICHOLS, LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5521
Mailing Address - Country:US
Mailing Address - Phone:256-718-4041
Mailing Address - Fax:256-718-3665
Practice Address - Street 1:426 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5521
Practice Address - Country:US
Practice Address - Phone:256-718-4041
Practice Address - Fax:256-718-3665
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16182207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL753040383OtherTAX ID
AL51515546OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL181487Medicaid
AL0009996510Medicaid
AL51507189OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL1021204158Medicare PIN
ALF25093Medicare UPIN
AL0009996510Medicaid