Provider Demographics
NPI:1669009908
Name:WADI, GHASSAN JAMAL (MD)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:JAMAL
Last Name:WADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY/ UT INTERNAL MEDICINE AND OBGYN CENTER
Mailing Address - Street 2:MEDICAL BUILDING B, SUITE 127
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-9410
Mailing Address - Fax:865-305-8261
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9340
Practice Address - Fax:865-305-9144
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program