Basic Information
| Provider Information | |||||||||
| NPI: | 1659327765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALGEE | ||||||||
| FirstName: | WYATT | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1067 VENDALL RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380241622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312859938 | ||||||||
| FaxNumber: | 7312878809 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 E TICKLE ST | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380243120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312859938 | ||||||||
| FaxNumber: | 7312878809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 6899 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 6899 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3897071 | 05 | TN | MEDICAID | 3897072 | 05 | TN | MEDICAID |