Individual
BLAKELY DAVID WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
20036 ZION AVE, STE 100, CORNELIUS, NC 28031-8435
(704) 801-7400
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-08866
NC
Other
Enumeration date
02/19/2019
Last updated
09/25/2025
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