Provider Demographics
NPI:1295974988
Name:NICHOLS, ANTONE M (DO)
Entity type:Individual
Prefix:DR
First Name:ANTONE
Middle Name:M
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MAC
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1723 UNIVERSITY AVE STE B
Mailing Address - Street 2:BOX 315
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-290-9091
Mailing Address - Fax:
Practice Address - Street 1:1723 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4109
Practice Address - Country:US
Practice Address - Phone:662-290-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS216272083B0002X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSFN1936256OtherDEA