Healthcare Provider Details

I. General information

NPI: 1306834908
Provider Name (Legal Business Name): WAVERLY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 E MAIN ST
WAVERLY TN
37185-1814
US

IV. Provider business mailing address

806 E MAIN ST PO BOX 786
WAVERLY TN
37185-1814
US

V. Phone/Fax

Practice location:
  • Phone: 931-296-7788
  • Fax: 931-296-7130
Mailing address:
  • Phone: 931-296-7788
  • Fax: 931-296-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUBHI D ALI
Title or Position: PRESIDENT
Credential: MD FACS
Phone: 931-296-7788