Healthcare Provider Details

I. General information

NPI: 1396919056
Provider Name (Legal Business Name): GEORGE WANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 MEDICAL CENTER EAST SOUTH TOWER 1215 21ST AVENUE SOUTH
NASHVILLE TN
37232-0001
US

IV. Provider business mailing address

7209 MEDICAL CENTER EAST SOUTH TOWER 1215 21ST AVENUE SOUTH
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 917-340-5060
  • Fax: 615-343-9556
Mailing address:
  • Phone: 917-340-5060
  • Fax: 615-343-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberP52860
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD45898
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: