Provider Demographics
NPI:1750583415
Name:NICOLS, LEE M (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:M
Last Name:NICOLS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1190 N STATE ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-944-1781
Mailing Address - Fax:601-353-0439
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-944-1781
Practice Address - Fax:601-353-0439
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2012-10-15
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Provider Licenses
StateLicense IDTaxonomies
MST-1706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery