Wagner, Anthony Mark

Wagner, Anthony Mark is an individual health care provider with primary practice located at 210 Simmons St , Maryville TN 37801. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Wagner, Anthony Mark can be contacted via phone (865) 970-9800.

Contact Information

Primary practice address
210 Simmons St Maryville TN 37801
Phone: (865) 970-9800
Fax: (865) 983-4518
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN129889 NP Georgia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 11134 Tennessee

Profile Details

NPI number 1659436830
LBN Legal business name Wagner, Anthony Mark
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2006
Last updated May 29th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659436830 NPPES
Tennessee MEDICAID 1514002

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