STEPHEN A NICKISCH M.D. NPI 1578596615

NPI Information

  • NPI: 1578596615
  • Provider Name: STEPHEN A NICKISCH, M.D.
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2060 DAN PROCTOR DR
    SUITE 1200
    SAINT MARYS, GA
    ZIP 31558
  • Phone: (912) 540-6750

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NPI Details

Stephen A Nickisch, M.D. is an obstetrics gynecology in Saint Marys, GA with 36 years of experience. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. Stephen A Nickisch, M.D. NPI is 1578596615. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
Graduation Year:1990

The provider's business location address is:

2060 DAN PROCTOR DR
SUITE 1200
SAINT MARYS, GA
ZIP 31558-894
Phone: (912) 540-6750
Fax: (912) 540-6773

The NPI 1578596615 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/9/2006 and was last updated on 8/18/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology10278MONTANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1000099105OTHERBCBS
2F85582MEDICARE UPIN
3011000188MEDICARE PIN
4000084435MEDICARE ID-TYPE UNSPECIFIEDMONTANAINDIVIDUAL MEDICARE NUMBE
50093279MEDICAIDMONTANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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