Provider Demographics
NPI:1982788311
Name:MCNICHOLS, JOHNNIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:
Last Name:MCNICHOLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 W MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-7320
Mailing Address - Country:US
Mailing Address - Phone:615-826-4464
Mailing Address - Fax:615-826-3208
Practice Address - Street 1:247 W MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7320
Practice Address - Country:US
Practice Address - Phone:615-826-4464
Practice Address - Fax:615-826-3208
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist