MEDICARE: MARY ELISABETH NEAL ANDERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	28500	TN
2	207R00000X	Internal Medicine Physician	28500	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386639136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELISABETH NEAL ANDERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-425-5752
Fax Number	:	731-425-5783

Provider Business Practice Location Address
First Line	:	2863 HIGHWAY 45 BYP
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3618
Country	:	US
Telephone Number	:	731-664-1375
Fax Number	:	731-660-8336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/28/2018

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