Provider Demographics
NPI:1306834908
Name:WAVERLY CLINIC PC
Entity Type:Organization
Organization Name:WAVERLY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUBHI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:931-296-7788
Mailing Address - Street 1:806 E MAIN ST
Mailing Address - Street 2:PO BOX 786
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1814
Mailing Address - Country:US
Mailing Address - Phone:931-296-7788
Mailing Address - Fax:931-296-7130
Practice Address - Street 1:806 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1814
Practice Address - Country:US
Practice Address - Phone:931-296-7788
Practice Address - Fax:931-296-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty