Provider Demographics
NPI:1992803829
Name:NICHOLLS, MATTHEW D (NP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:NICHOLLS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON RD NE BLDG A
Mailing Address - Street 2:THE EMORY CLINIC - PULMONARY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-3261
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE BLDG A
Practice Address - Street 2:THE EMORY CLINIC - PULMONARY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN152626363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care