Provider Demographics
NPI:1922776616
Name:ANDERSON, JEREMIAH D
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 7 LKS S
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9601
Mailing Address - Country:US
Mailing Address - Phone:678-362-1700
Mailing Address - Fax:
Practice Address - Street 1:2320 7 LKS S
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-9601
Practice Address - Country:US
Practice Address - Phone:678-362-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies