MEDICARE: MS. EMILY GEA WALLER APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	28722	TN

General Provider Information

NPI Number	:	1215500020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY GEA WALLER APN

Provider Business Mailing Address
First Line	:	741 PRESIDENT PL STE 200
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6809
Country	:	US
Telephone Number	:	615-459-7104
Fax Number	:	615-459-7104

Provider Business Practice Location Address
First Line	:	741 PRESIDENT PL STE 200
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6809
Country	:	US
Telephone Number	:	615-459-7104
Fax Number	:	615-459-7104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	07/20/2021

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