Individual
MATTHEW WISDOM
Active
Individual
MATTHEW WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25851
SC
208M00000X
Hospitalist Physician
069150
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003131332A
—
GA
05
—
258517
—
SC
01
—
BW8511948
CONTROLLED SUBSTANCE REGI
SC
01
—
TL25851
LICENSE NUMBER
SC
Enumeration date
07/22/2006
Last updated
03/26/2018
Update your record
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