Provider Demographics
NPI:1831591320
Name:NICHOLS, JOANNE (RN)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 REX RD
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3971
Mailing Address - Country:US
Mailing Address - Phone:404-675-9880
Mailing Address - Fax:404-675-9888
Practice Address - Street 1:2054 REX RD
Practice Address - Street 2:SUITE 5A
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3971
Practice Address - Country:US
Practice Address - Phone:404-675-9880
Practice Address - Fax:404-675-9888
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177669163W00000X
MARN235135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse