Active NPI
Melanie P. Nicholls, MD
- Internal Medicine Physician
- Dothan, AL
National Provider Identifier
1841293792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 25418
- Practice address
- 210 Westside Dr
Dothan, AL 36303-1928 - Phone
- (334) 793-5074
- Fax
- (334) 793-6460
- NPI assigned
- May 24, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 25418 | AL | Primary |
Addresses
Primary practice location
210 Westside Dr
Dothan, AL 36303-1928
Mailing address
2855 Ross Clark Cir
Dothan, AL 36301-2013
Phone (334) 794-7847
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009926185 | Medicaid | AL | |
| P00045558 | Other | RAILROAD MEDICARE |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25418 | AL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1841293792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2855 ROSS CLARK CIR",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363012013",
"telephone_number": "334-794-7847",
"fax_number": "334-794-2453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 WESTSIDE DR",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363031928",
"telephone_number": "334-793-5074",
"fax_number": "334-793-6460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLLS",
"first_name": "MELANIE",
"middle_name": "P.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-05-24",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AL",
"license": "25418",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009926185",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00045558",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.