Provider Demographics
NPI:1538264064
Name:GWALTNEY, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GWALTNEY
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 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-844-3919
Mailing Address - Fax:423-975-0141
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-3919
Practice Address - Fax:423-975-0141
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15402208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0102OtherJOHN DEERE NOW UNITED HC
TN027541OtherINDV ANTHEM/GROUP #093410
TN0636398OtherUMWA GROUP
WV7300140000Medicaid
VA7304692Medicaid
TN3008207Medicaid
TNF03906748OtherCHAMPUS GROUP
TN022276800OtherBLACK LUNG GROUP
TN4546155OtherAETNA
TN770000847OtherMCRAILROAD/GROUP#CA8128
TN2001924OtherBCBS OF TENNESSEE
TNA97268Medicare UPIN
TNF03906748OtherCHAMPUS GROUP
TN2001924OtherBCBS OF TENNESSEE
TN4546155OtherAETNA
WV7300140000Medicaid