Healthcare Provider Details

I. General information

NPI: 1780748616
Provider Name (Legal Business Name): WILLIAM R NELSON M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 LUCY CORR CIR
CHESTERFIELD VA
23832-6697
US

IV. Provider business mailing address

9501 LUCY CORR CIR P. O. BOX 100
CHESTERFIELD VA
23832-6697
US

V. Phone/Fax

Practice location:
  • Phone: 804-751-4385
  • Fax: 804-751-4497
Mailing address:
  • Phone: 804-751-4385
  • Fax: 804-751-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101031658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: