Healthcare Provider Details

I. General information

NPI: 1033198486
Provider Name (Legal Business Name): DAVID A WYCKOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MURPHY AVE SUITE 201
NASHVILLE TN
37203
US

IV. Provider business mailing address

2201 MURPHY AVE SUITE 201
NASHVILLE TN
37203-1835
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-3595
  • Fax: 615-891-4442
Mailing address:
  • Phone: 615-329-3595
  • Fax: 615-327-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000037368
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: