Healthcare Provider Details

I. General information

NPI: 1184039471
Provider Name (Legal Business Name): MIRIAM WOZNY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRIAM WOZNY DO

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 AMERICAN WAY STE 1
MEMPHIS TN
38118
US

IV. Provider business mailing address

4095 AMERICAN WAY STE 1
MEMPHIS TN
38118-8339
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-9500
  • Fax: 865-342-0120
Mailing address:
  • Phone: 901-271-9500
  • Fax: 865-342-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3329
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3329
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3329
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: