Healthcare Provider Details

I. General information

NPI: 1912946690
Provider Name (Legal Business Name): ROBERT WOJTANOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 HIGHWAY 411 N
ETOWAH TN
37331-1912
US

IV. Provider business mailing address

3211 SHANNON RD SUITE 300
DURHAM NC
27707-6322
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-3600
  • Fax: 423-263-3601
Mailing address:
  • Phone: 919-403-2028
  • Fax: 919-419-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29941
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: