Provider Demographics
NPI:1144779646
Name:WAGAW, MEZEMIR FIKREMARIAM
Entity Type:Individual
Prefix:MR
First Name:MEZEMIR
Middle Name:FIKREMARIAM
Last Name:WAGAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PLUS PARK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-1022
Mailing Address - Country:US
Mailing Address - Phone:615-562-3457
Mailing Address - Fax:615-562-3458
Practice Address - Street 1:325 PLUS PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1022
Practice Address - Country:US
Practice Address - Phone:615-562-3457
Practice Address - Fax:615-562-3458
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN344600000X
344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi