Provider Demographics
NPI:1417076290
Name:NELSON, BRETT ARIC (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ARIC
Last Name:NELSON
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 1:1255 E COLLEGE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4515
Mailing Address - Country:US
Mailing Address - Phone:931-363-3086
Mailing Address - Fax:
Practice Address - Street 1:1255 E COLLEGE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4515
Practice Address - Country:US
Practice Address - Phone:931-363-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061500207R00000X
TN0000050726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166171001Medicaid
AR5H022OtherBCBS
AR5H022OtherBCBS