MEDICARE: DR. DAVID WALLACE NEBLETT M.D.

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	2080S0010X	Pediatric Sports Medicine Physician	58132	TN

General Provider Information

NPI Number	:	1720466741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WALLACE NEBLETT M.D.

Provider Business Mailing Address
First Line	:	6746 CHARLOTTE PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4204
Country	:	US
Telephone Number	:	629-203-7585
Fax Number	:	629-203-7857

Provider Business Practice Location Address
First Line	:	6746 CHARLOTTE PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-4204
Country	:	US
Telephone Number	:	629-203-7585
Fax Number	:	629-203-7857

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

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	11/05/2021

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