Individual
MRS. MARY ELIZABETH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
496 FAIRFIELD CT, EVANS, GA 30809-3641
(229) 292-9248
Mailing address
3647 J DEWEY GRAY CIR STE 200, AUGUSTA, GA 30909-2205
(706) 504-9712
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN213344
GA
363LF0000X
Family Nurse Practitioner
RN213344
GA
Other
Enumeration date
01/21/2014
Last updated
01/04/2022
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