Provider Demographics
NPI:1235273673
Name:WAYNE E TASKER
Entity Type:Organization
Organization Name:WAYNE E TASKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMOGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-581-8844
Mailing Address - Street 1:1329 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3728
Mailing Address - Country:US
Mailing Address - Phone:423-581-8844
Mailing Address - Fax:423-318-3050
Practice Address - Street 1:1329 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3728
Practice Address - Country:US
Practice Address - Phone:423-581-8844
Practice Address - Fax:423-318-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW12081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513170Medicaid
TN3730027Medicaid
TN36946802OtherGROUP MEDICARE #
TN36946802OtherGROUP MEDICARE #
TN3694689Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE