Provider Demographics
NPI:1457549891
Name:NICHOLS, BRANDON WOODFIN (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:WOODFIN
Last Name:NICHOLS
Suffix:
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 1:101 MEMORIAL HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1787
Mailing Address - Country:US
Mailing Address - Phone:251-414-5900
Mailing Address - Fax:
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1787
Practice Address - Country:US
Practice Address - Phone:251-414-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS215152085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04450554Medicaid
MS302I303578Medicare PIN