Provider Demographics
NPI:1609338748
Name:BONETT, WYNDHAM ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:WYNDHAM
Middle Name:ALEXANDER
Last Name:BONETT
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:PO BOX 197517
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-7517
Mailing Address - Country:US
Mailing Address - Phone:423-648-8480
Mailing Address - Fax:423-648-8481
Practice Address - Street 1:135 N MEADOWS DR STE C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4172
Practice Address - Country:US
Practice Address - Phone:423-648-8480
Practice Address - Fax:423-648-8481
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.41341207LP2900X
TN71520208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine