Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DNF000247 | GA |
NPI | 1003861352 |
---|---|
Provider Name | Dr. Steven Kent Nelson |
First Address | Augusta, GA 30912-0002 |
Second Address | Augusta, GA 30912-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZG0247 | (05) | SC |