Healthcare Provider Details

I. General information

NPI: 1205878220
Provider Name (Legal Business Name): WALTER EARNEST STEPHENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CREEKSIDE DR
DICKSON TN
37055-2176
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-441-6140
  • Fax: 615-441-6190
Mailing address:
  • Phone: 615-851-6033
  • Fax: 615-851-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32001
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32001
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: