Healthcare Provider Details

I. General information

NPI: 1235123787
Provider Name (Legal Business Name): KEITH H NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-2350
  • Fax: 252-744-6937
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200101254
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: