Provider Demographics
NPI:1649362781
Name:WEARNER, NEAL E (MD)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:E
Last Name:WEARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5301 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-221-4474
Mailing Address - Fax:615-234-3774
Practice Address - Street 1:5301 VIRGINIA WAY
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7541
Practice Address - Country:US
Practice Address - Phone:615-221-4474
Practice Address - Fax:615-234-3774
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN17234207ZP0102X
KY20398207ZP0102X
GA041383207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3038897Medicaid
TN000005004152OtherTLC TENNCARE
GA10054168OtherAMERIGROUP GA MEDICAIDCMO
NC89065TFMedicaid
TN0083093OtherBLUE CROSS
TN119585OtherUNISON TENNCARE
KY64798085Medicaid
GA319823OtherWELLCARE MEDICAID GA CMO
GA52349478003OtherBLUE CROSS
TN0083093OtherBLUE CROSS
TN3038890Medicare ID - Type Unspecified
KY64798085Medicaid