MEDICARE: DR. CECIL TRIPP HURON NELSON III M.D.

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	207V00000X	Obstetrics & Gynecology Physician	LL32606	SC
2	207VM0101X	Maternal & Fetal Medicine Physician	32606	SC
3	207VM0101X	Maternal & Fetal Medicine Physician	54447	TN

General Provider Information

NPI Number	:	1548571540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECIL TRIPP HURON NELSON III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 ALCOA HWY STE 435
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1520
Country	:	US
Telephone Number	:	865-305-8888
Fax Number	:

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	03/05/2020

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