Provider Demographics
NPI:1225680820
Name:NELSON, NOEL URIAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:URIAH
Last Name:NELSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 HIGHWAY 36 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-6150
Mailing Address - Country:US
Mailing Address - Phone:770-504-2462
Mailing Address - Fax:
Practice Address - Street 1:2978 HIGHWAY 36 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-6150
Practice Address - Country:US
Practice Address - Phone:770-504-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230703163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse