Healthcare Provider Details

I. General information

NPI: 1508783507
Provider Name (Legal Business Name): JASON JASON TIEDEMANN PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

IV. Provider business mailing address

51 ROBERTS CHAPEL RD
PIEDMONT AL
36272-6939
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-5000
  • Fax:
Mailing address:
  • Phone: 256-913-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0100679
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: