Provider Demographics
NPI:1255400362
Name:WAWA, FRITZ (MD)
Entity type:Individual
Prefix:
First Name:FRITZ
Middle Name:
Last Name:WAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 NOLENSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4717
Mailing Address - Country:US
Mailing Address - Phone:615-834-2170
Mailing Address - Fax:615-833-6995
Practice Address - Street 1:4126 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4717
Practice Address - Country:US
Practice Address - Phone:615-834-2170
Practice Address - Fax:615-833-6995
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG37943Medicare UPIN