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Individual

DR. JUSTIN WADE WIDNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1610 TAZEWELL RD STE 203, TAZEWELL, TN 37879-3648
(423) 259-3701
(866) 954-5783
Mailing address
PO BOX 15004, KNOXVILLE, TN 37901-5004
(865) 541-8895
(865) 633-4808

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3903
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Q042576
TN
Enumeration date
05/25/2017
Last updated
04/08/2022
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