Provider Demographics
NPI:1912285446
Name:NELSON, EDMOND COLLIN JR (MD)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:COLLIN
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1150 SOUTH GREEN STREET
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-377-5009
Mailing Address - Fax:662-377-5071
Practice Address - Street 1:1150 S GREEN ST STE 1A
Practice Address - Street 2:NORTH MISSISSIPPI MEDICAL CENCER
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4902
Practice Address - Country:US
Practice Address - Phone:662-377-5009
Practice Address - Fax:662-377-5071
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23146207R00000X
ALMD.32419207R00000X
WVWV-SE-1846207R00000X
AZ65734207R00000X, 208M00000X
LA321099207R00000X, 208M00000X
GA79603208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine