Provider Demographics
NPI:1063416436
Name:MOREDOCK, AARON M (PAC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:MOREDOCK
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:ONE VANTAGE WAY
Mailing Address - Street 2:SUITE B 240
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228
Mailing Address - Country:US
Mailing Address - Phone:615-329-4020
Mailing Address - Fax:615-329-9479
Practice Address - Street 1:2000 CHURCH STREET
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236
Practice Address - Country:US
Practice Address - Phone:615-284-8484
Practice Address - Fax:615-284-3854
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
TN855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMM1252989OtherDEA NUMBER
TNMM1252989OtherDEA NUMBER
P45855Medicare UPIN