Provider Demographics
NPI:1740913367
Name:NICHOLS, BROOKE E (ATC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E VICTORY DR APT 126
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3971
Mailing Address - Country:US
Mailing Address - Phone:315-528-7022
Mailing Address - Fax:
Practice Address - Street 1:2200 E VICTORY DR APT 126
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3971
Practice Address - Country:US
Practice Address - Phone:315-528-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer