MEDICARE: NES TENNESSEE, INC.

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4023660	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427039858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NES TENNESSEE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 198733
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8733
Country	:	US
Telephone Number	:	800-377-8721
Fax Number	:	304-697-1155

Provider Business Practice Location Address
First Line	:	2835 HIGHWAY 231 N
Second Line	:
City	:	SHELBYVILLE
State	:	TN
Zip	:	37160-7327
Country	:	US
Telephone Number	:	931-685-8989
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SERGE MARTIAL
Credential	:
Telephone Number	:	800-377-8721

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	04/12/2011

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Directions to “NES TENNESSEE, INC. ” Practice Location

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