Basic Information
| Provider Information | |||||||||
| NPI: | 1942539242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTER B NELSON MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9218 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366910218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2515441926 | ||||||||
| FaxNumber: | 2514602846 | ||||||||
| Practice Location | |||||||||
| Address1: | 1970 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSDALE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386147202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626215088 | ||||||||
| FaxNumber: | 6626143299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2009 | ||||||||
| LastUpdateDate: | 07/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | HUNTER | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2515441926 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 15688 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000891228B | 01 | GA | GA MEDICAID | OTHER | 15688 | 01 | MS | MEDICAL LICENSE | OTHER | 30BDJTQ | 01 | GA | GA MEDICARE | OTHER |