Provider Demographics
NPI:1245497908
Name:NELSON, ERIC CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHARLES
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 1:979 E 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2187
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-757-0770
Practice Address - Street 1:979 E 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2187
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-757-0770
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48252208600000X
TNMD48252208C00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL153664Medicaid
P01276012OtherRR MEDICARE
TN4354499OtherBCBS
TNQ002628Medicaid
GA003135926AMedicaid
TNQ002628Medicaid
GA003135926AMedicaid