Healthcare Provider Details

I. General information

NPI: 1972505535
Provider Name (Legal Business Name): WAYLAND REED NORWOOD AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 S JEFFERSON AVE SUITE 8
COOKEVILLE TN
38501-4278
US

IV. Provider business mailing address

728 S JEFFERSON AVE SUITE 8
COOKEVILLE TN
38501-4278
US

V. Phone/Fax

Practice location:
  • Phone: 931-854-9499
  • Fax: 931-854-9460
Mailing address:
  • Phone: 931-854-9499
  • Fax: 931-854-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number88
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: