Individual
DR. DEREK LAMONT WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 DR DB TODD JR BLVD, NASHVILLE, TN 37208-3501
(615) 327-6385
Mailing address
1562 CRESTVIEW DR APT 306, MADISON, TN 37115-2195
(336) 407-5982
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
4301512090
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2022
Last updated
03/30/2026
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