Healthcare Provider Details

I. General information

NPI: 1811340722
Provider Name (Legal Business Name): WESLEY NEUROLOGY CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 CENTERVIEW PKWY SUITE 305 & 101
CORDOVA TN
38018-4227
US

IV. Provider business mailing address

8000 CENTERVIEW PKWY SUITE 305
CORDOVA TN
38018-4227
US

V. Phone/Fax

Practice location:
  • Phone: 901-624-2960
  • Fax: 901-624-2961
Mailing address:
  • Phone: 901-624-2960
  • Fax: 901-624-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NANCY BAKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-624-2960