Healthcare Provider Details

I. General information

NPI: 1104826163
Provider Name (Legal Business Name): ROBERT W HATFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: R. WAYNE HATFIELD M.D.

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 OLD HICKORY BLVD
BRENTWOOD TN
37027-4203
US

IV. Provider business mailing address

828 OLD HICKORY BLVD
BRENTWOOD TN
37027-4203
US

V. Phone/Fax

Practice location:
  • Phone: 865-386-5555
  • Fax: 865-386-5555
Mailing address:
  • Phone: 865-386-5555
  • Fax: 865-386-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD0000028878
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: