Individual
BETHANY ANN WARDLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1893 S HIGHLAND AVE, JACKSON, TN 38301-7799
(731) 423-5585
(731) 423-5587
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 423-8697
(731) 422-5743
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45434
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518613
—
TN
Enumeration date
03/16/2007
Last updated
11/29/2012
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