Provider Demographics
NPI:1912078353
Name:NELMS FAMILY & PREVENTIVE MEDICINE, P.A.
Entity Type:Organization
Organization Name:NELMS FAMILY & PREVENTIVE MEDICINE, P.A.
Other - Org Name:FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-399-0707
Mailing Address - Street 1:2546 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-399-0707
Mailing Address - Fax:252-291-7079
Practice Address - Street 1:2546 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-399-0707
Practice Address - Fax:252-291-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000001081876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01471OtherBCBS OF NC
2315940Medicare ID - Type Unspecified