Healthcare Provider Details

I. General information

NPI: 1073040911
Provider Name (Legal Business Name): WADE CLAYTON GOBBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD STE 130
KNOXVILLE TN
37923-4205
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-4861
  • Fax: 865-693-0338
Mailing address:
  • Phone: 865-694-0062
  • Fax: 865-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number67906
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: