Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 946 | TN |
NPI | 1003829748 |
---|---|
Provider Name | Theodore H Ameredes |
First Address | Dalton, GA 30722-2563 |
Second Address | Bowling Green, KY 42104-3362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 03/03/2017 |