Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD00010366 | TN |
NPI | 1013948090 |
---|---|
Provider Name | George H. Treadwell III |
First Address | Germantown, TN 38138-1746 |
Second Address | Memphis, TN 38119-4810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3190955 | (05) | TN |
B04447 | (02) | TN |