Nicholson, Theodore

Nicholson, Theodore is an individual health care provider with primary practice located at 705 Dixie St , Carrollton GA 30117-3818. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Nicholson, Theodore can be contacted via phone (770) 836-9666.

Contact Information

Primary practice address
705 Dixie St Carrollton GA 30117-3818
Phone: (770) 836-9666
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 029920 Georgia
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 029920 Georgia

Profile Details

NPI number 1275590051
LBN Legal business name Nicholson, Theodore
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Apr 28th, 2010 - about 14 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 1275590051 NPPES
Georgia MEDICAID 000390288B

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