Provider Demographics
NPI:1548248529
Name:NICHOLS, JOHN EDWIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWIN
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:17 CALEDON CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3170
Mailing Address - Country:US
Mailing Address - Phone:864-232-7734
Mailing Address - Fax:864-232-7099
Practice Address - Street 1:17 CALEDON CT
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3170
Practice Address - Country:US
Practice Address - Phone:864-232-7734
Practice Address - Fax:864-232-7099
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-07-23
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Provider Licenses
StateLicense IDTaxonomies
SC19655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist