Provider Demographics
NPI:1538270640
Name:NICHOLS, ERNEST JAMES (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:JAMES
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 WILLOW GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9638
Mailing Address - Country:US
Mailing Address - Phone:704-895-4975
Mailing Address - Fax:
Practice Address - Street 1:12501 WILLOW GROVE WAY
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9638
Practice Address - Country:US
Practice Address - Phone:704-895-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer