Provider Demographics
NPI:1851421218
Name:ARTIE NELSON
Entity Type:Organization
Organization Name:ARTIE NELSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTIE
Authorized Official - Middle Name:CORTEZ
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-985-4939
Mailing Address - Street 1:3825 LORNA RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3005
Mailing Address - Country:US
Mailing Address - Phone:205-985-4939
Mailing Address - Fax:205-985-4431
Practice Address - Street 1:3825 LORNA RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3005
Practice Address - Country:US
Practice Address - Phone:205-985-4939
Practice Address - Fax:205-985-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL155312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00082808Medicaid
ALE91044Medicare UPIN