Individual
JENNIFER M WISHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
665 GAINES SCHOOL RD., ATHENS, GA 30605
(706) 369-8115
Mailing address
2 BLACK OAK CT, CRAWFORD, GA 30630-1900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT008975
GA
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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