Healthcare Provider Details

I. General information

NPI: 1023206075
Provider Name (Legal Business Name): RACHEL A NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 GOODWIN RD
CHATTANOOGA TN
37421-3182
US

IV. Provider business mailing address

PO BOX 6159
CHATTANOOGA TN
37401-6159
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-3252
  • Fax: 423-894-2237
Mailing address:
  • Phone: 423-894-3252
  • Fax: 423-894-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101663
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48251
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: