Provider Demographics
NPI:1093155913
Name:NIELSEN, ANDREW KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KARL
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W JAMES M CAMPBELL BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4672
Mailing Address - Country:US
Mailing Address - Phone:931-380-0075
Mailing Address - Fax:931-388-7502
Practice Address - Street 1:854 W JAMES M CAMPBELL BLVD STE 403
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4659
Practice Address - Country:US
Practice Address - Phone:931-380-0075
Practice Address - Fax:931-388-7502
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57809208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710089Medicaid