MEDICARE: DR. NATHAN DALE NELSON JR. PHARMD

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	183500000X	Pharmacist	RPH030197	GA

General Provider Information

NPI Number	:	1447862735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN DALE NELSON JR. PHARMD

Provider Business Mailing Address
First Line	:	4617 JONESBORO RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-2048
Country	:	US
Telephone Number	:	770-969-7458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 JONESBORO RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-2048
Country	:	US
Telephone Number	:	770-969-7485
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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