Healthcare Provider Details

I. General information

NPI: 1588675276
Provider Name (Legal Business Name): WILDER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LAKE VIEW STE A WILDER CLINIC
SUNERVILLE TN
38068
US

IV. Provider business mailing address

201 LAKE VIEW STE A WILDER CLINIC
SUNERVILLE TN
38068
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-6353
  • Fax: 901-465-5948
Mailing address:
  • Phone: 901-465-6353
  • Fax: 901-465-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK S MCKNIGHT
Title or Position: OWNER
Credential: MD
Phone: 901-465-6353