Healthcare Provider Details

I. General information

NPI: 1851810774
Provider Name (Legal Business Name): PHYSICIAN HOPE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915C CHURCH ST
NASHVILLE TN
37203-2203
US

IV. Provider business mailing address

1915C CHURCH ST
NASHVILLE TN
37203-2203
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-1121
  • Fax: 615-321-1202
Mailing address:
  • Phone: 615-321-1121
  • Fax: 615-321-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DALE MANLEY
Title or Position: OFFICE MANAGER
Credential: APRN
Phone: 615-321-1121