MEDICARE: DR. CLAY THOMAS NELSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8316	TN

General Provider Information

NPI Number	:	1134229008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAY THOMAS NELSON D.D.S.

Provider Business Mailing Address
First Line	:	871 MOUNT MORIAH RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-5704
Country	:	US
Telephone Number	:	901-682-4366
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 MOUNT MORIAH RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-5704
Country	:	US
Telephone Number	:	901-682-4366
Fax Number	:	901-682-7698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	05/30/2014

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