Donald Bryce Nelson Jr., DENTIST

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DNO12543 Issued in ID

Practice address

105 S Laurel St
Springfield, GA 31329-9255

Phone

(912) 754-6822

Fax

(912) 754-4368

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Effingham Dental Associates,P.C.

  • Dental Clinic/Center
  • Springfield, GA
  • NPI 1275687642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1508937210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S LAUREL ST",
            "city": "SPRINGFIELD",
            "state": "GA",
            "postal_code": "313299255",
            "telephone_number": "912-754-6822",
            "fax_number": "912-754-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S LAUREL ST",
            "city": "SPRINGFIELD",
            "state": "GA",
            "postal_code": "313299255",
            "telephone_number": "912-754-6822",
            "fax_number": "912-754-4368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON JR.",
        "first_name": "DONALD",
        "middle_name": "BRYCE",
        "name_prefix": "Dr.",
        "credential": "DENTIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "DNO12543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1687448",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL",
            "identifier": "9184109",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• MPPG, Inc.
• MPPG, Inc.
• MPPG, Inc.
• Madeline Neal
• Brenda Ned
• Robert Dean Nelson, DENTIST
• Lauren Elaine Spradley Oglesby, MD
• Optim Orthopedics, LLC
• Steven John Pabst, RPH
• Kelly Paddrik, RDN, LD

• All providers in Springfield, GA
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.