=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306072301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES ROGER NELSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2009
-----------------------------------------------------
Last Update Date | 06/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 TRIMBLE PLANT RD
-----------------------------------------------------
City | SOUTHERN PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28387-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-246-5333
-----------------------------------------------------
Fax | 910-246-5330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MONTCLAIR LN
-----------------------------------------------------
City | PINEHURST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28374-8602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-255-6225
-----------------------------------------------------
Fax | 910-255-6225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 200900177
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------