Individual
GINA M WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
210 25TH AVE N STE 1204, NASHVILLE, TN 37203-1620
(615) 312-0600
(615) 320-3259
Mailing address
210 25TH AVE N STE 1204, NASHVILLE, TN 37203-1620
(615) 312-0600
(615) 320-3259
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD43570
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1504830
—
TN
05
—
1505028
—
TN
01
—
4185805
BCBS
TN
01
—
4186061
BCBS
TN
05
—
7100061080
—
KY
01
—
P00640522
RAILROAD MEDICARE
—
01
—
P00732359
RAILROAD MEDICARE (CIC)
TN
Enumeration date
03/13/2007
Last updated
03/04/2021
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