Provider Demographics
NPI:1437373644
Name:BREWER, NELSON SHELBY (M D)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:SHELBY
Last Name:BREWER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5652
Mailing Address - Country:US
Mailing Address - Phone:706-485-3645
Mailing Address - Fax:
Practice Address - Street 1:137 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5652
Practice Address - Country:US
Practice Address - Phone:706-485-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95508OtherFLORIDA LICENSE NUMBER
GA040874OtherGEORGIA LICENSE NUMBER
FLME95508OtherFLORIDA LICENSE NUMBER