Sheredrick Anthony Edmundson

Primary specialty

ContractorTaxonomy code 171W00000X

License

00017384 Issued in TN

Practice address

4233 Shagbark TRL
Antioch, TN 37013-7311

Phone

(615) 578-2541

Fax

(615) 280-1160

NPI assigned

Jul 19, 2011

Last updated

Jul 19, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1902194434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4233 SHAGBARK TRL",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370137311",
            "telephone_number": "615-578-2541",
            "fax_number": "615-280-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4233 SHAGBARK TRL",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370137311",
            "telephone_number": "615-578-2541",
            "fax_number": "615-280-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMUNDSON",
        "first_name": "SHEREDRICK",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "TN",
            "license": "00017384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Contractor in Antioch, TN
• Providers in Antioch, TN by specialty
• Contractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.