Individual provider · Type 1 NPI

Derek Lamont Wagner, MD

Student in an Organized Health Care Education/Training Program · Nashville, TN

NPI number 1659012169 Active

Practice location

1005 Dr Db Todd Jr Blvd
Nashville, TN 37208-3501

Call (615) 327-6385 Map

Mailing address

1562 Crestview Dr Apt 306
Madison, TN 37115-2195

Other practice locations

  • 6071 W Outer Dr, Detroit, MI 48235-2624 · (313) 966-3300

Specialties and licenses

TaxonomyCodeLicense
General Practice Physician 208D00000X4301512090 (MI)
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1659012169

Derek Lamont Wagner, MD's National Provider Identifier is 1659012169, issued on Apr 6, 2022. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Nashville, TN. The record was last updated on Mar 30, 2026.