Provider Demographics
NPI:1932561131
Name:NELSON, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N WESTOVER BLVD
Mailing Address - Street 2:STE C5
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2145
Mailing Address - Country:US
Mailing Address - Phone:229-234-2817
Mailing Address - Fax:
Practice Address - Street 1:101 OAKLAND CROSSING DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-7228
Practice Address - Country:US
Practice Address - Phone:229-432-1440
Practice Address - Fax:229-889-8263
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily