Healthcare Provider Details

I. General information

NPI: 1629063854
Provider Name (Legal Business Name): WALLACE R MCGREW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 23RD AVE N STE 300 SUITE 300
NASHVILLE TN
37203-1690
US

IV. Provider business mailing address

330 23RD AVE N STE 300 SUITE 300
NASHVILLE TN
37203-1690
US

V. Phone/Fax

Practice location:
  • Phone: 615-342-5900
  • Fax: 615-342-6084
Mailing address:
  • Phone: 615-342-5900
  • Fax: 615-342-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD13612
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: