Provider Demographics
NPI:1164674818
Name:WAWA LLC
Entity Type:Organization
Organization Name:WAWA LLC
Other - Org Name:HARDING MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-834-2170
Mailing Address - Street 1:4126 NOLENSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4717
Mailing Address - Country:US
Mailing Address - Phone:615-834-2170
Mailing Address - Fax:615-833-6995
Practice Address - Street 1:4126 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4717
Practice Address - Country:US
Practice Address - Phone:615-834-2170
Practice Address - Fax:615-833-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27619261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG37943Medicare UPIN