| Doctor Name: | GREGORY SPENCER WAMACK |
| NPI Number: | 1053741876 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN, APRN, FNP-C |
| License Number: | 18124 |
| Business Practice Address: | 931 Old Smithville Rd Mcminnville, TN - 371105934 |
| Business Phone Number: | 9312594144 |
| Business Fax Number: | 9312594143 |
| Mailing Address: | 931 Old Smithville Rd, MCMINNVILLE |
| State: | TN |
| Postal Code: | 371105934 |
| Phone Number: | 9312594144 |
| Fax Number: | 9312594143 |
| NPI Enumeration Date: | 11/14/2013 |
| NPI Last Update Date: | 11/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 18124 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |