Provider Demographics
NPI:1982877973
Name:NELSON, JOHN SHELTON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SHELTON
Last Name:NELSON
Suffix:
Gender:M
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:P O BOX 1000 DEPT 457
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7888
Mailing Address - Fax:901-266-6425
Practice Address - Street 1:1251 WESLEY DR STE 151
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6443
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-266-6425
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49685208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001088Medicaid