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:
Health care specialties
| Specialty | Code | License # | 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 4 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 | 1790759579 | NPPES |
| Other | 2106119 | HIGHMARK | |
| MEDICAID | 1023118620001 | HIGHMARK |
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