Active NPI
Teresa Nicholson, CNM
- Advanced Practice Midwife
- Saint Marys, GA
National Provider Identifier
1184972887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- RN103935
- Practice address
- 104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803 - Phone
- (912) 882-7100
- Fax
- (912) 882-9149
- NPI assigned
- Aug 28, 2012
- Last updated
- Dec 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | RN103935 | GA | Primary |
| General Practice Registered Nurse | 163WG0000X | RN103935 | GA |
Addresses
Primary practice location
104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803
Mailing address
104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803
Phone (912) 882-7100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003127951B | Medicaid | GA | |
| 003127951A | Medicaid | GA | |
| 202I422481 | Other | GA | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN103935 | GA | MD | Advanced Practice Midwife |
Interoperability endpoints
- teresa.nicholson.p73@direct.tenet.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481500800000",
"number": "1184972887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 LAKESHORE DR",
"address_2": "STE A",
"city": "SAINT MARYS",
"state": "GA",
"postal_code": "315583803",
"telephone_number": "912-882-7100",
"fax_number": "912-882-9149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 LAKESHORE DR",
"address_2": "STE A",
"city": "SAINT MARYS",
"state": "GA",
"postal_code": "315583803",
"telephone_number": "912-882-7100",
"fax_number": "912-882-9149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "TERESA",
"credential": "CNM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-28",
"last_updated": "2016-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "GA",
"license": "RN103935",
"primary": true
},
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "GA",
"license": "RN103935",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003127951B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003127951A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "202I422481",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Marys, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.