Provider Demographics
NPI:1447410600
Name:NELSON, JEREMY SEBASTIAN (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:SEBASTIAN
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 1:2221 BONNIEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3820
Mailing Address - Country:US
Mailing Address - Phone:478-284-1020
Mailing Address - Fax:
Practice Address - Street 1:2221 BONNIEWOOD DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3820
Practice Address - Country:US
Practice Address - Phone:478-284-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072048207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine