Individual
ANDREW JACKSON ETHERIDGE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCA, CFO, CFM, CPED
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
—
—
224900000X
Mastectomy Fitter
—
—
224L00000X
Pedorthist
—
—
225000000X
Orthotic Fitter
—
—
229N00000X
Anaplastologist
Primary
—
—
Other
Enumeration date
02/11/2021
Last updated
08/30/2022
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