Individual
DR. NELSON GWINN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1150 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 712-1929
(334) 712-2799
Mailing address
1150 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 712-1929
(334) 712-2799
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
15644
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000055299
—
AL
05
—
000088713
—
AL
05
—
00459225B
—
GA
05
—
009941307
—
AL
01
—
051055299
BLUE CROSS
AL
01
—
051088713
BLUE CROSS
AL
01
—
051538730
BLUE CROSS
AL
01
—
051540195
BLUE CROSS
AL
05
—
054182600
—
FL
05
—
258388700
—
FL
05
—
529301110
—
AL
01
—
61699
BLUE CROSS
FL
01
—
631087996
TAX ID#
—
Enumeration date
01/16/2006
Last updated
02/03/2011
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