Provider Demographics
NPI:1295755528
Name:NICHOLLS, BERKELEY H (DPM)
Entity type:Individual
Prefix:DR
First Name:BERKELEY
Middle Name:H
Last Name:NICHOLLS
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:1916 PATTERSON ST STE 600
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2159
Practice Address - Country:US
Practice Address - Phone:615-321-3668
Practice Address - Fax:615-321-3618
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000359213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351581Medicaid
TN3351581Medicare PIN
TNT51502Medicare UPIN
TN5820550001Medicare NSC