Provider Demographics
NPI:1417901794
Name:NELSON, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:17 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-4000
Mailing Address - Country:US
Mailing Address - Phone:731-855-4283
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:TN
Practice Address - Zip Code:38369-9711
Practice Address - Country:US
Practice Address - Phone:731-665-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4088427OtherBCBS PROVIDER NUMBER
TN157873OtherUNISON PROVIDER NUMBER
TN32094OtherTLC PROVIDER NUMBER
TN3898024Medicaid
TN8081169OtherCIGNA HEALTHCARE PROVIDER
TN7725301OtherAETNA PROVIDER NUMBER
TN4088427OtherBCBS PROVIDER NUMBER
TN3898024Medicaid