Individual
MR. ATHAN ANDERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4000 COAST GUARD BLVD, PORTSMOUTH, VA 23707-2199
(757) 483-8710
(757) 483-8716
Mailing address
1324 DARIEN COURT, VIRGINIA BEACH, VA 23464-8808
(757) 463-6674
(757) 483-8716
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
B1625287
CA
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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