Provider Demographics
NPI:1760446884
Name:WANDASS, JOSEPH HENRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HENRY
Last Name:WANDASS
Suffix:III
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 1:300 STEAM PLANT RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-328-3750
Mailing Address - Fax:615-328-3758
Practice Address - Street 1:300 STEAM PLANT RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-328-3750
Practice Address - Fax:615-328-3758
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51485207R00000X
NY213374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354150Medicaid
TNQ029454Medicaid
NYRA6411Medicare ID - Type Unspecified
NY00354150Medicaid