Provider Demographics
NPI:1194796326
Name:NELSON, JAMES CHARLES JR (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHARLES
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2546 WINDLE COMMUNITY RD.
Mailing Address - Street 2:
Mailing Address - City:RICKMAN
Mailing Address - State:TN
Mailing Address - Zip Code:38580
Mailing Address - Country:US
Mailing Address - Phone:931-498-4880
Mailing Address - Fax:931-498-4882
Practice Address - Street 1:2546 WINDLE COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:RICKMAN
Practice Address - State:TN
Practice Address - Zip Code:38580
Practice Address - Country:US
Practice Address - Phone:931-498-4880
Practice Address - Fax:931-498-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37202M001Medicaid
TN37202M001Medicaid
TN3871579Medicare PIN