Basic Information
| Provider Information | |||||||||
| NPI: | 1215029756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESLEY NEUROLOGY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 UNION AVE | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017258920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1211 UNION AVE | ||||||||
| Address2: | STE. 400 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017258920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WANG | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9017258920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 30878 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.