Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | RES.3426 | OH |
Y | 1223P0221X | Pediatric Dentist | 10182 | TN |
NPI | 1073928412 |
---|---|
Provider Name | Dr. Laurel Ayres Meriwether |
First Address | Kingsport, TN 37664-2032 |
Second Address | Johnson City, TN 37604-3033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 26/08/2016 |