Provider Demographics
NPI:1841293792
Name:NICHOLLS, MELANIE P (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:P
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2013
Mailing Address - Country:US
Mailing Address - Phone:334-794-7847
Mailing Address - Fax:334-794-2453
Practice Address - Street 1:210 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1928
Practice Address - Country:US
Practice Address - Phone:334-793-5074
Practice Address - Fax:334-793-6460
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009926185Medicaid
P00045558OtherRAILROAD MEDICARE
ALH89188Medicare UPIN
AL051553926Medicare ID - Type UnspecifiedMEDICARE NUMBER