Individual
MATTHEW WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342
(404) 851-8146
(404) 851-6325
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
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
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