Provider Demographics
NPI:1952836165
Name:NELSON, KAMARIA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:KAMARIA
Middle Name:NICOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 WASHGINTON ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-814-6104
Mailing Address - Fax:762-224-2177
Practice Address - Street 1:4150 WASHGINTON ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-814-6104
Practice Address - Fax:762-224-2177
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100937207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program