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General NPI Number Information
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NPI Number | 1760881098
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Entity Type | Individual
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Provider Name | WENDELL WAINWRIGHT M.S.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 08/22/2014
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Provider Practice Location Address
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Address Line | 245 RIVERDALE DRIVE
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City | OAKLAND
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State | TN
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Zip | 38060
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Country | US
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Telephone | 901-465-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 245 RIVERDALE DR
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City | OAKLAND
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State | TN
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Zip | 38060-5341
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Country | US
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Telephone | 901-465-0033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000113
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License Number State | TN
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