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Individual

JOHN D WISE III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
600 E NORTHSIDE DR, SUITE D, CLINTON, MS 39056-3437
(601) 925-9473
(601) 925-9490
Mailing address
600 E NORTHSIDE DR, SUITE D, CLINTON, MS 39056-3437
(601) 925-9473
(601) 925-9490

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5337740001
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02053764
MS
Enumeration date
12/13/2010
Last updated
01/04/2011
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