| Doctor Name: | TODD R NICHOLSON |
| NPI Number: | 1396749032 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A. |
| License Number: | 103000 |
| Business Practice Address: | 3349 Us Hwy 1 Vass, NC - 28394 |
| Business Phone Number: | 9102457678 |
| Business Fax Number: | 9102451444 |
| Mailing Address: | Po Box 647, VASS |
| State: | NC |
| Postal Code: | 283940647 |
| Phone Number: | 9102457678 |
| Fax Number: | 9102451444 |
| NPI Enumeration Date: | 06/10/2005 |
| NPI Last Update Date: | 12/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 103000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |