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NPI Code Detail

MEDICARE: AUDREY ANNE WAGNER MD

MEDICARE: AUDREY ANNE WAGNER 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
1207Q00000XFamily Medicine Physician76333TN
2390200000XStudent in an Organized Health Care Education/Training Program
3207Q00000XFamily Medicine PhysicianME158286FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619556388
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY ANNE WAGNER MD
Provider Business Mailing Address
First Line : 2711 FOSTER AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37210-5307
Country : US
Telephone Number : 573-673-0000
Fax Number :
Provider Business Practice Location Address
First Line : 617 S 8TH ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37206-3819
Country : US
Telephone Number : 615-227-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2021
Last Update Date : 02/12/2026

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Directions to “ AUDREY ANNE WAGNER MD” Practice Location

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