Provider Demographics
NPI:1104985340
Name:NELSON, JAMES D (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WALNUT GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-7925
Mailing Address - Country:US
Mailing Address - Phone:423-775-5512
Mailing Address - Fax:423-775-0155
Practice Address - Street 1:149 WALNUT GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-7925
Practice Address - Country:US
Practice Address - Phone:423-775-5512
Practice Address - Fax:423-775-0155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3008582Medicaid
TN10011360OtherPHP CARITEN
NEBCBSOther37544
TNTN0101OtherJOHN DEERE HEALTH
621654001OtherFEDERAL TAX ID
TN3008582Medicaid