Provider Demographics
NPI:1245448620
Name:MEADERS, JERRY FRANK (RPH)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:FRANK
Last Name:MEADERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 SHADOW POINT CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5372
Mailing Address - Country:US
Mailing Address - Phone:423-242-8300
Mailing Address - Fax:
Practice Address - Street 1:1710 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8313
Practice Address - Country:US
Practice Address - Phone:706-259-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0557430001Medicare ID - Type Unspecified