Provider Demographics
NPI:1316974215
Name:WILWAYCO, STEPHANIE D (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:WILWAYCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1317
Mailing Address - Country:US
Mailing Address - Phone:615-222-1900
Mailing Address - Fax:615-222-1917
Practice Address - Street 1:5201 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209
Practice Address - Country:US
Practice Address - Phone:615-222-1900
Practice Address - Fax:615-222-1917
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN29092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3816991Medicaid
TN4141512OtherBLUE CROSS
TN3063729OtherBCBS
3816999OtherMEDICARE
TN3816991Medicaid
TN4141512OtherBLUE CROSS