Healthcare Provider Details

I. General information

NPI: 1184812117
Provider Name (Legal Business Name): THE WOOTTON CLINIC AND MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 WOLF RIVER BLVD SUITE 112
GERMANTOWN TN
38138-1708
US

IV. Provider business mailing address

7730 WOLF RIVER BLVD SUITE 112
GERMANTOWN TN
38138-1708
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-2424
  • Fax: 901-756-7504
Mailing address:
  • Phone: 901-756-2424
  • Fax: 901-756-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID M WOOTTON
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 901-756-2424