Provider Demographics
NPI:1760915383
Name:STROUD, MEREDITH RISSLER (DO)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:RISSLER
Last Name:STROUD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1039 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7900
Practice Address - Country:US
Practice Address - Phone:423-874-0125
Practice Address - Fax:423-874-0154
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4119208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics