Provider Demographics
NPI:1861761769
Name:GILES, NELSON BLAKE (EMT-IV)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:BLAKE
Last Name:GILES
Suffix:
Gender:M
Credentials:EMT-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 LEATH ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-2615
Mailing Address - Country:US
Mailing Address - Phone:901-834-2900
Mailing Address - Fax:
Practice Address - Street 1:956 LEATH ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-2615
Practice Address - Country:US
Practice Address - Phone:901-834-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104882749172A00000X
TN37400146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No172A00000XOther Service ProvidersDriver