Mancel Wakham LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MANCEL WAKHAM LLC

Practice address

1000 Bradford Way Ste 500
Kingston, TN 37763-3126

Phone

(865) 621-3601

Fax

(865) 409-5733

NPI assigned

Oct 17, 2024

Last updated

Oct 17, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mancel Wakhem, MD

Title

Owner

Phone

(865) 621-3601

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Joseph Ampudia, M.D.

  • Surgery Physician
  • Newport, TN
  • NPI 1437127610

  Family Medicine

  Medicare reassignment NPD
• Amanda Collier

  • Family Nurse Practitioner
  • Byrdstown, TN
  • NPI 1669857850
  Medicare reassignment NPD
• Mancel Wayne Wakham, DO

  • Family Medicine Physician
  • Harriman, TN
  • NPI 1073568218
  Medicare reassignment NPD
• Madelynn Paige Henson

  • Family Nurse Practitioner
  • Muscle Shoals, AL
  • NPI 1669285599

  TN

  Medicare reassignment NPD
• Catherine Cochran Smelley

  • Family Nurse Practitioner
  • Florence, AL
  • NPI 1962087650

  TN

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1487475067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BRADFORD WAY STE 500",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377633126",
            "telephone_number": "865-621-3601",
            "fax_number": "865-409-5733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BRADFORD WAY STE 500",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377633126",
            "telephone_number": "865-621-3601",
            "fax_number": "865-409-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCEL WAKHAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "WAKHEM",
        "authorized_official_first_name": "MANCEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-621-3601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Hendrick Lewis, L.C.S.W.
• Lexie Lewis, PHARMD
• Lighthouse Therapy Services, LLC
• Sarah Littlefield, MED LMFT
• McKayla Locke, M.S., CCC-SLP
• Michelle Parker McCullough, PHARMD
• Chandra McMullen
• Michael Dunn Center
• Michael Dunn Center
• Michael Dunn Center

• Family Medicine Physician in Kingston, TN
• Providers in Kingston, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.