Healthcare Provider Details

I. General information

NPI: 1134539075
Provider Name (Legal Business Name): JEFFREY SCOTT NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PRIMACY PKWY
MEMPHIS TN
38119
US

IV. Provider business mailing address

1301 PRIMACY PKWY UNIV OF TENNESSEE, SAINT FRANCIS FAMILY MEDICINE
MEMPHIS TN
38119-0213
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-0276
  • Fax:
Mailing address:
  • Phone: 901-448-0230
  • Fax: 901-448-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55881
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number55881
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: