Provider Demographics
NPI:1770651598
Name:WAGNER ASSOCIATES PC
Entity Type:Organization
Organization Name:WAGNER ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:PARKS
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-212-5301
Mailing Address - Street 1:679 EMORY VALLEY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-212-5301
Mailing Address - Fax:865-220-0782
Practice Address - Street 1:679 EMORY VALLEY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-212-5301
Practice Address - Fax:865-220-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000000600103TC0700X
TNP0000001265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3067696OtherBCBS
TN78130OtherBCBS
TN3680317Medicaid
TN3682388Medicaid
TN3682388Medicaid
TN3067696OtherBCBS