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NPI Code Detail

MEDICARE: CONNOR WAYNE GATEWOOD MD

MEDICARE: CONNOR WAYNE GATEWOOD MD
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
12084N0402XNeurology with Special Qualifications in Child Neurology Physician71160TN

General Provider Information

NPI Number : 1497215594
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR WAYNE GATEWOOD MD
Provider Business Mailing Address
First Line : 850 POPLAR AVE BLDG 2
Second Line :
City : MEMPHIS
State : TN
Zip : 38105-4607
Country : US
Telephone Number : 901-287-6943
Fax Number : 901-287-6804
Provider Business Practice Location Address
First Line : 848 ADAMS AVE # L400
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-2816
Country : US
Telephone Number : 901-287-6804
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2019
Last Update Date : 01/13/2026

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