# WAVERLY PEDIATRIC AND ADULT CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962796888
- **Authorized official:** DR. MARY ANGELA SKELTON M.D. (OWNER)
- **Authorized official phone:** (931) 296-7000

## Contact information

- **Practice address:** 1034 W MAIN ST, WAVERLY, TN 37185-1447
- **Practice address phone:** (931) 296-7000
- **Practice address fax:** (931) 296-7231
- **Mailing address:** 1034 W MAIN ST, WAVERLY, TN 37185-1447
- **Mailing address phone:** (931) 296-7000
- **Mailing address fax:** (931) 296-7231

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | MD8719 | TN | Yes |
| 364SF0001X | Family Health Clinical Nurse Specialist | APN0000015777 | TN | — |

## Other

- **Enumeration date:** 06/08/2011
- **Last updated:** 06/08/2011