Basic Information
| Provider Information | |||||||||
| NPI: | 1790941334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLVERTON | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | OLIVER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153775602 | ||||||||
| FaxNumber: | 6152711692 | ||||||||
| Practice Location | |||||||||
| Address1: | 4305 NEW SHEPHERDSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BARDSTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400049019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023505000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | VAD 000 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 04033 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.