MEDICARE: THE DOCTORS GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD16070	TN

General Provider Information

NPI Number	:	1891995494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DOCTORS GROUP

Provider Business Mailing Address
First Line	:	119 E FORT ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-1508
Country	:	US
Telephone Number	:	931-728-0939
Fax Number	:	931-728-1950

Provider Business Practice Location Address
First Line	:	119 E FORT ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-1508
Country	:	US
Telephone Number	:	931-728-0939
Fax Number	:	931-728-1950

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DR. GREGORY STEPHEN WILEY I
Credential	:	M.D.
Telephone Number	:	931-728-0939

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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