1497952600 NPI number — MANCEL WAKHAM, DO PC

Table of content: MUHAMMAD FAISAL ASLAM MD (NPI 1356863062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497952600 NPI number — MANCEL WAKHAM, DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANCEL WAKHAM, DO PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497952600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2497 S ROANE ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
HARRIMAN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-230-5698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2497 S ROANE ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
HARRIMAN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-590-0889
Provider Business Practice Location Address Fax Number:
865-590-0884
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PACKETT
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
865-321-0048

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D00000000982 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3725874 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com