Healthcare Provider Details

I. General information

NPI: 1093155913
Provider Name (Legal Business Name): ANDREW KARL NIELSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 W JAMES M CAMPBELL BLVD STE 403
COLUMBIA TN
38401-4659
US

IV. Provider business mailing address

854 W JAMES M CAMPBELL BLVD STE 303
COLUMBIA TN
38401-4672
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-0075
  • Fax: 931-388-7502
Mailing address:
  • Phone: 931-380-0075
  • Fax: 931-388-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57809
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57809
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: