Individual
DR. SUSAN DIANNE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
353 NEW SHACKLE ISLAND RD, SUITE 247C, HENDERSONVILLE, TN 37075-2379
(615) 824-5064
(615) 824-0195
Mailing address
353 NEW SHACKLE ISLAND RD, SUITE 247C, HENDERSONVILLE, TN 37075-2379
(615) 824-5064
(615) 824-0195
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20189
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3048949
—
TN
Enumeration date
05/11/2006
Last updated
12/07/2010
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