Wise, Terrence

Wise, Terrence is an individual health care provider with primary practice located at 1255 Highway 54 W , Fayetteville GA 30214-4526. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wise, Terrence can be contacted via phone (770) 719-5630.

Contact Information

Primary practice address
1255 Highway 54 W Fayetteville GA 30214-4526
Phone: (770) 719-5630
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 056246 Georgia

Profile Details

NPI number 1790759579
LBN Legal business name Wise, Terrence
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 16th, 2006
Last updated Mar 6th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790759579 NPPES
Other 2106119 HIGHMARK
MEDICAID 1023118620001 HIGHMARK

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