MEDICARE: DAVID GRAHAM NELSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4021	GA

General Provider Information

NPI Number	:	1295163517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GRAHAM NELSON LPC

Provider Business Mailing Address
First Line	:	592 HARDENDORF AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1780
Country	:	US
Telephone Number	:	404-295-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 CLAIREMONT AVE
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-2506
Country	:	US
Telephone Number	:	404-308-8548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	10/23/2013

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