Healthcare Provider Details

I. General information

NPI: 1104985340
Provider Name (Legal Business Name): JAMES D NELSON M.D., F.A.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 WALNUT GROVE CHURCH RD
DAYTON TN
37321-7925
US

IV. Provider business mailing address

149 WALNUT GROVE CHURCH RD
DAYTON TN
37321-7925
US

V. Phone/Fax

Practice location:
  • Phone: 423-775-5512
  • Fax: 423-775-0155
Mailing address:
  • Phone: 423-775-5512
  • Fax: 423-775-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000015680
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: