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General NPI Number Information
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NPI Number | 1487475067
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Entity Type | Organization
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Legal Business Name | MANCEL WAKHAM LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1000 BRADFORD WAY STE 500
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City | KINGSTON
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State | TN
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Zip | 37763-3126
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Country | US
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Telephone | 865-621-3601
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Fax | 865-409-5733
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Provider Business Mailing Address
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Address Line | 1000 BRADFORD WAY STE 500
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City | KINGSTON
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State | TN
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Zip | 37763-3126
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Country | US
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Telephone | 865-621-3601
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Fax | 865-409-5733
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANCEL WAKHEM
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Credential | MD
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Telephone | 865-621-3601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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