DR. PHIL OTIS NELSON JR. (NPI# 1063890754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063890754 |
| Entity Type | Individual |
| Full Name | DR. PHIL OTIS NELSON JR. |
| Credential | M.D. |
| Practice Address |
146 Ridge Dr Jackson MS 39216-4109 |
| Practice Telephone | 6019825793 |
| Practice Fax Number | 6019843631 |
| Mailing Telephone | 6019825793 |
| Mailing Fax Number | 6019843631 |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2015-05-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
04082 | MS | Allopathic & Osteopathic Physicians |
| Street Address |
146 RIDGE DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891030946 | Cherry Hill Radiology Pllc | Radiology | 401 Redfield Dr, Jackson, TN 38305-8555 | 2012-11-30 |
| 1245414275 | Breathit County Imaging Center | Radiology | 1389 Ky Hwy 15 North, St. John Newmans Medical Plaza, Jackson, KY 41339 | 2007-12-27 |
| 1407933930 | Karen Collette Jensen | Radiology | 14 Adams Road, Jackson, NH 03846 | 2006-11-01 |
| 1770676801 | Gerald O Daniel | Radiology | 708 W Forest Avenue, Jackson, TN 38301 | 2006-10-02 |
| 1497761837 | Arlin George Hatfield IIi | Radiology | 1405 North State Street, Suite 200, Jackson, MS 39202 | 2006-07-31 |
| 1225083942 | Robert Houston Hardin Jr. | Radiology | 2210 Heritage Hill Dr, Jackson, MS 39211-5821 | 2006-05-23 |
| 1881655967 | Jane Warne Brown | Radiology | 91 Stonehaven Cir, Jackson, TN 38305-1945 | 2006-03-29 |
| 1780645028 | Andrew Laurence Rivard | Radiology | 2500 State Street, University of Mississippi Medical Center, Jackson, MS 39216 | 2006-03-28 |
| 1013985134 | John A. Sullivan | Radiology | 7330 Ryegrass Road, Jackson, WY 83001 | 2006-03-14 |
| 1508830225 | Katharine A Yoler | Radiology | 715 Snow King Dr, Jackson, WY 83001-8301 | 2006-02-17 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.