Provider Demographics
NPI:1093500498
Name:NELSON, TANNER K (MD)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:K
Last Name:NELSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 SLOMAN PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5562
Mailing Address - Country:US
Mailing Address - Phone:804-310-5236
Mailing Address - Fax:
Practice Address - Street 1:811 W MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2500
Practice Address - Country:US
Practice Address - Phone:803-358-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program