MEDICARE: DR. JOSE M THECKEDATH 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	207K00000X	Allergy & Immunology Physician	GA45992	GA

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	:	1982798047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE M THECKEDATH MD

Provider Business Mailing Address
First Line	:	1911 PALMYRA RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-1574
Country	:	US
Telephone Number	:	229-446-7227
Fax Number	:	229-420-4365

Provider Business Practice Location Address
First Line	:	1911 PALMYRA RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-1574
Country	:	US
Telephone Number	:	229-446-7227
Fax Number	:	229-420-4365

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/20/2013

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Directions to “ DR. JOSE M THECKEDATH MD” Practice Location

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