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General NPI Number Information
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NPI Number | 1144177056
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Entity Type | Organization
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Legal Business Name | WJG MULTISPECIALTY CLINIC PC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 625 BROADWAY # 625A
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City | BANGOR
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State | ME
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Zip | 04401-3375
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Country | US
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Telephone | 207-605-5593
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Fax | 207-407-7289
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Provider Business Mailing Address
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Address Line | 4900 CENTENNIAL BLVD STE 300
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City | NASHVILLE
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State | TN
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Zip | 37209-1105
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Country | US
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Telephone | 615-364-8603
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WOODRUFF HALL BAUM
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Credential |
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Telephone | 646-568-0193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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