Provider Demographics
NPI:1518995810
Name:NELSON, NORMAN CROOKS JR (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:CROOKS
Last Name:NELSON
Suffix:JR
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 1:160 WATER TOWER CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4873
Mailing Address - Country:US
Mailing Address - Phone:478-757-8806
Mailing Address - Fax:478-757-8667
Practice Address - Street 1:160 WATER TOWER CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4873
Practice Address - Country:US
Practice Address - Phone:478-757-8806
Practice Address - Fax:478-757-8667
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00503445AMedicaid
GAF09192Medicare UPIN
GA00503445AMedicaid