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General NPI Number Information
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NPI Number | 1497952600
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Entity Type | Organization
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Legal Business Name | MANCEL WAKHAM, DO PC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 2497 S ROANE ST SUITE 110
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City | HARRIMAN
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State | TN
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Zip | 37748
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Country | US
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Telephone | 865-590-0889
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Fax | 865-590-0884
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Provider Business Mailing Address
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Address Line | 2497 S ROANE ST SUITE 110
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City | HARRIMAN
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State | TN
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Zip | 37748
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Country | US
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Telephone | 865-230-5698
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LISA PACKETT
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Credential |
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Telephone | 865-321-0048
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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 | D00000000982
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License Number State | TN
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