Individual
NELSON BLAKE GILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EMT-IV
Contact information
Practice address
956 LEATH ST, MEMPHIS, TN 38107-2615
(901) 834-2900
Mailing address
956 LEATH ST, MEMPHIS, TN 38107-2615
(901) 834-2900
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
37400
TN
172A00000X
Driver
104882749
TN
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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