Provider Demographics
NPI:1831422682
Name:NISHIMURA, KOJI (MD)
Entity type:Individual
Prefix:
First Name:KOJI
Middle Name:
Last Name:NISHIMURA
Suffix:
Gender:M
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:COMMANDER, USAMEDDAC AND MARTIN ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:7950 MARTIN LOOP
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:706-544-4618
Mailing Address - Fax:
Practice Address - Street 1:COMMANDER, USAMEDDAC AND MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:7950 MARTIN LOOP
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-4618
Practice Address - Fax:706-544-3163
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054889207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine