Organization
MANCEL WAKHAM, DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA PACKETT (MANAGER)
(865) 321-0048
Entity
Organization
Contact information
Practice address
2497 S ROANE ST, SUITE 110, HARRIMAN, TN 37748
(865) 590-0889
(865) 590-0884
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
D00000000982
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3725874
—
TN
Enumeration date
06/29/2007
Last updated
07/24/2020
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