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Wendy Tipton Oberdick
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NPI Number Detailed Information
Provider Information:
| Name: | Wendy Tipton Oberdick |
| Gender: | F |
| Provider License Number If Given: | MD46567 |
NPI Information:
| NPI: | 1659374601 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 10/20/2011 |
Provider Business Mailing Address:
| Address: | PO BOX 9 Kingsport, TN 37662 |
| Phone Number: | 4238572066 |
| Fax Number: | 4238572070 |
Provider Business Practice Location Address:
| Address: | 105 W STONE DR STE 1F Kingsport, TN 37660 |
| Phone Number: | 4232302420 |
| Fax Number: | 4232302422 |
Provider Taxonomy:
| Primary: | 207Q00000X |
| Secondary (if any): | 207Q00000X |
| State: | TN |
