Provider Demographics
NPI:1083813398
Name:NICHOLS, MARTHA EASLER (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:EASLER
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2411 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4635
Mailing Address - Country:US
Mailing Address - Phone:706-733-1999
Mailing Address - Fax:706-721-1701
Practice Address - Street 1:2411 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4635
Practice Address - Country:US
Practice Address - Phone:706-733-1999
Practice Address - Fax:706-721-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0318642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology