Provider Demographics
NPI:1740677517
Name:WAGNER, EVELEIGH (MD)
Entity type:Individual
Prefix:
First Name:EVELEIGH
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVELEIGH
Other - Middle Name:
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:381 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-9000
Mailing Address - Country:US
Mailing Address - Phone:615-244-9800
Mailing Address - Fax:615-224-9840
Practice Address - Street 1:381 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 460
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-9000
Practice Address - Country:US
Practice Address - Phone:615-224-9800
Practice Address - Fax:615-224-9840
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2799342084P0800X
TN592252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry