Provider Demographics
NPI:1437425915
Name:NELSON, SEAN TREVAR (DO)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:TREVAR
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:SEAN
Other - Middle Name:TREVAR
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:655 SOUTH 7TH STREET BLDG 700/700A
Mailing Address - Street 2:78 MDG/SGOF
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098
Mailing Address - Country:US
Mailing Address - Phone:478-327-8487
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 700700A
Practice Address - Street 2:78 MDG/SGOF
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine