MEDICARE: MARIA NELSON

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	363LF0000X	Family Nurse Practitioner	RN168345	GA

General Provider Information

NPI Number	:	1932561131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA NELSON

Provider Business Mailing Address
First Line	:	515 N WESTOVER BLVD
Second Line	:	STE C5
City	:	ALBANY
State	:	GA
Zip	:	31707-2145
Country	:	US
Telephone Number	:	229-234-2817
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 OAKLAND CROSSING DR
Second Line	:
City	:	LEESBURG
State	:	GA
Zip	:	31763-7228
Country	:	US
Telephone Number	:	229-432-1440
Fax Number	:	229-889-8263

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

Provider Enumeration Date	:	03/26/2016
Last Update Date	:	08/19/2021

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