Healthcare Provider Details

I. General information

NPI: 1598546210
Provider Name (Legal Business Name): WAYSPRING CLINIC IA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 10TH AVE S STE 350
NASHVILLE TN
37203-4166
US

IV. Provider business mailing address

209 10TH AVE S STE 350
NASHVILLE TN
37203-4166
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-3555
  • Fax:
Mailing address:
  • Phone: 615-345-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICE HEYWOOD
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 615-345-3555