Provider Demographics
NPI:1831159912
Name:NICHOLS, DAWN W (MD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:W
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 E EMERALD AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4540
Mailing Address - Country:US
Mailing Address - Phone:865-524-2547
Mailing Address - Fax:865-524-0224
Practice Address - Street 1:939 E EMERALD AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4540
Practice Address - Country:US
Practice Address - Phone:865-524-2547
Practice Address - Fax:865-524-0224
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000037081207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38882711Medicaid
KY6407204400Medicaid
TN38882711Medicaid
P00470474Medicare PIN
H02426Medicare UPIN