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Individual

DR. JOSE M THECKEDATH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1911 PALMYRA RD, ALBANY, GA 31701-1574
(229) 446-7227
(229) 420-4365
Mailing address
1911 PALMYRA RD, ALBANY, GA 31701-1574
(229) 446-7227
(229) 420-4365

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
GA45992
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000840386A
GA
Enumeration date
10/03/2006
Last updated
03/20/2013
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