Mancel Wakham, DO PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D00000000982 Issued in TN

Legal business name

MANCEL WAKHAM, DO PC

Practice address

2497 S Roane St
Suite 110
Harriman, TN 37748

Phone

(865) 590-0889

Fax

(865) 590-0884

NPI assigned

Jun 29, 2007

Organization subpart

No

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

Authorized official

Name

Lisa Packett

Title

Manager

Phone

(865) 321-0048

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1497952600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2497 S ROANE ST",
            "address_2": "SUITE 110",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "37748",
            "telephone_number": "865-230-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2497 S ROANE ST",
            "address_2": "SUITE 110",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "37748",
            "telephone_number": "865-590-0889",
            "fax_number": "865-590-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCEL WAKHAM, DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "PACKETT",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "865-321-0048"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "D00000000982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3725874",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Laymance, FNP
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• Kaylee Marie Loy, CPNP-PC
• LP Harriman LLC
• Sharon Mansoor
• Paula A Margrave, RPH
• Mark B Hellmann DPM
• Tameshia Nicole Martin, MS CCCSLP
• Massage Therapy by Jeff Pressley

• Family Medicine Physician in Harriman, TN
• Providers in Harriman, 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 Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.