William Lawrence Nicholson, M.D.

Key facts

NPI

1851789580

Entity type

Individual (NPI type 1)

Primary specialty

Otolaryngology Physician 207Y00000X

License

13070 (GA)

Practice address

360 W 37TH St
Sea Island, GA 31561-9748

Phone

(912) 634-9036

NPI assigned

Jan 5, 2015

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Medicine

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 5, 2015.

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420416000000",
    "number": "1851789580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31103",
            "city": "SEA ISLAND",
            "state": "GA",
            "postal_code": "315611103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 W 37TH ST",
            "city": "SEA ISLAND",
            "state": "GA",
            "postal_code": "315619748",
            "telephone_number": "912-634-9036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "WILLIAM",
        "middle_name": "LAWRENCE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "13070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}