Nicholson, Justin Doyle

Nicholson, Justin Doyle is an individual health care provider with primary practice located at 101 Riverstone Vis Ste 102 , Blue Ridge GA 30513-6630. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Nicholson, Justin Doyle can be contacted via phone (706) 258-4140.

Contact Information

Primary practice address
101 Riverstone Vis Ste 102 Blue Ridge GA 30513-6630
Phone: (706) 258-4140
Fax: (706) 258-4141
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN209728 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN209728 Georgia

Profile Details

NPI number 1457806184
LBN Legal business name Nicholson, Justin Doyle
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2016
Last updated Aug 19th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457806184 NPPES
Georgia Other G00351A MEDICARE PTAN
Georgia MEDICAID 003202905B MEDICARE PTAN
Georgia MEDICAID 003202905A MEDICARE PTAN

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