Wiist, Lance Jordan
Wiist, Lance Jordan is an individual health care provider with primary practice located at 761 Old Norcross Rd , Lawrenceville GA 30046-4317. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Wiist, Lance Jordan can be contacted via phone (770) 513-4000.Contact Information
Primary practice address
761 Old Norcross Rd
Lawrenceville GA 30046-4317
Phone: (770) 513-4000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 033754 | Georgia |
Profile Details
| NPI number | 1487708103 |
|---|---|
| LBN Legal business name | Wiist, Lance Jordan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 22nd, 2007 |
| Last updated | Dec 16th, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487708103 | NPPES |
| Georgia | MEDICAID | 00446993A | |
| Georgia | Other | 619666 | |
| Georgia | Other | 160054732 | |
| Georgia | Other | 000446993A | |
| Georgia | Other | 00446993A |
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