Basic Information
| Provider Information | |||||||||
| NPI: | 1013948090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREADWELL | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7205 WOLF RIVER BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017576100 | ||||||||
| FaxNumber: | 9017576109 | ||||||||
| Practice Location | |||||||||
| Address1: | ALLERGY ASTHMA IMMUNOLOGY CENTER PLLC | ||||||||
| Address2: | 6401 POPLAR AVENUE SUITE 300 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381194810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017516100 | ||||||||
| FaxNumber: | 9017576109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | MD00010366 | TN | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 3190955 | 05 | TN | MEDICAID |