Individual
GRANT NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
121 N 20TH ST STE 6, OPELIKA, AL 36801-5454
(334) 749-3385
Mailing address
653 W 8TH ST # L18, JACKSONVILLE, FL 32209-6511
(904) 244-3907
(904) 244-4685
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1829
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216697
—
AL
Enumeration date
03/30/2015
Last updated
08/24/2018
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