Provider Demographics
NPI:1184889594
Name:NICHOLS, VIVIAN L (LMT)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 E ANDREWS DR NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1368
Mailing Address - Country:US
Mailing Address - Phone:404-841-0090
Mailing Address - Fax:404-262-8974
Practice Address - Street 1:110 E ANDREWS DR NW
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1368
Practice Address - Country:US
Practice Address - Phone:404-841-0090
Practice Address - Fax:404-262-8974
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist