Individual
THOMAS WILLIAM PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
561 KAILORS COVE CIR, RINGGOLD, GA 30736-3372
(423) 580-8896
Mailing address
561 KAILORS COVE CIR, RINGGOLD, GA 30736-3372
(423) 580-8896
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001751
TN
103TC0700X
Clinical Psychologist
PSY002564
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235954957B
—
GA
01
—
3138951
BCBS W PARADIGM
TN
05
—
3584286
—
TN
01
—
680011023
RR MEDICARE W PARADIGM
TN
Enumeration date
09/19/2006
Last updated
03/20/2014
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