Provider Demographics
NPI:1912615600
Name:ANDERSON, GERELDA ARLENE
Entity type:Individual
Prefix:
First Name:GERELDA
Middle Name:ARLENE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6358 FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-7430
Mailing Address - Country:US
Mailing Address - Phone:615-746-7173
Mailing Address - Fax:
Practice Address - Street 1:6358 FRIENDSHIP CHURCH RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-7430
Practice Address - Country:US
Practice Address - Phone:615-746-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210008491347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker