Healthcare Provider Details

I. General information

NPI: 1699688879
Provider Name (Legal Business Name): LAURA MATTSON WADSWORTH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 WESTGATE CIR STE 100
BRENTWOOD TN
37027-8091
US

IV. Provider business mailing address

812 LITTLE SPRINGS RD
CLARKSVILLE TN
37040-5492
US

V. Phone/Fax

Practice location:
  • Phone: 615-277-3971
  • Fax: 615-221-7079
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: