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General NPI Number Information
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NPI Number | 1396973665
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Entity Type | Individual
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Provider Name | MS. WANDA DENISE NELSON
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Gender | Female
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 02/15/2010
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Provider Practice Location Address
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Address Line | 3275 CREEKWAY LN
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City | DECATUR
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State | GA
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Zip | 30034-4909
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Country | US
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Telephone | 404-243-3865
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Fax | 404-243-4368
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Provider Business Mailing Address
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Address Line | 3275 CREEKWAY LN
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City | DECATUR
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State | GA
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Zip | 30034-4909
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Country | US
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Telephone | 404-243-3865
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Fax | 888-320-1559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 211D00000X
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Taxonomy Name | Podiatric Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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