Basic Information
| Provider Information | |||||||||
| NPI: | 1205827334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLSON | ||||||||
| FirstName: | BARNEY | ||||||||
| MiddleName: | MATHEWS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 NORTHPOINTE CV | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392112912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019772233 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | VAMC | ||||||||
| Address2: | 1500 E WOODROW WILSON DR (112) | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G 74505 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.