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General NPI Number Information
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NPI Number | 1417136086
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Entity Type | Individual
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Provider Name | SHIRLEY JEAN MEREDITH MD
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Gender | Female
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 125 FAIRFAX AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4905
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Country | US
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Telephone | 502-708-2780
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Fax | 502-805-0788
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Provider Business Mailing Address
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Address Line | 125 FAIRFAX AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4905
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Country | US
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Telephone | 502-708-2780
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Fax | 502-805-0788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 049920
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35. 072880
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 16175
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 41773
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License Number State | KY
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