Individual
MANCEL WAYNE WAKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2497 S. ROANE ST., SUITE 110, HARRIMAN, TN 37748
(865) 230-5698
Mailing address
2497 S. ROANE ST., SUITE 110, HARRIMAN, TN 37748
(865) 230-5698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
982
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0140287
UNITED HEALTHCARE
—
01
—
4091772
BLUE CROSS BLUE SHIELD
TN
01
—
P00114578
MEDICARE TRAVELERS
—
05
—
Q036092
—
TN
01
—
TN0101
JOHN DEERE HEALTHCARE
—
Enumeration date
05/24/2006
Last updated
07/08/2018
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