person
Gary Glenn Nichols, PA
Medical Physician Assistant in North Wilkesboro, North Carolina
NPI 1316936156

Gary Glenn Nichols is a Medical Physician Assistant based in Charlotte, NC and is specialized in Medical. Gary Glenn Nichols practices in North Wilkesboro, NC and has the professional credentials of PA. The NPI Number for Gary Glenn Nichols is 1316936156 and holds a License No. 100253 (North Carolina).

The current practice location address for Gary Glenn Nichols is 1404 Willow Ln, North Wilkesboro, NC and can be reached out via phone at 336-667-0335 and via fax at 336-667-4434.

Location: 1404 Willow Ln, North Wilkesboro, NC, 28260-2658
person
Provider Profile Details
NPI Number
1316936156
Provider Name
Gary Glenn Nichols
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
1404 Willow Ln, North Wilkesboro, NC, 28260-2658
Phone Number
336-667-0335
Fax Number
336-667-4434
Provider Enumeration Date
10/14/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2750028C 01 NC MEDICARE PTAN, INDIVIDUAL
5905127 05 NE
203994F 01 NC MEDICARE GROUP
2335816 01 NC MEDICARE PTAN, GROUP
institution
Provider Business Practice Location Address Details
Address
1404 Willow Ln
City
State
Zip
28659-3584
Phone Number
336-667-0335
Fax Number
336-667-4434
person
Provider Business Mailing Address Details
Address
1404 Willow Ln
City
State
Zip
28659-3584
Phone Number
336-667-0335
Fax Number
336-667-4434
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
100253 (North Carolina)
Definition
Definition to come...
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