Healthcare Provider Details

I. General information

NPI: 1538264064
Provider Name (Legal Business Name): DAVID GWALTNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD
BRISTOL TN
37620-7430
US

IV. Provider business mailing address

PO BOX 632476
CINCINNATI OH
45263-2476
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-3919
  • Fax: 423-975-0141
Mailing address:
  • Phone: 423-844-3919
  • Fax: 423-975-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15402
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: