Individual
DR. MARK WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3000 SCHATULGA RD BLDG 5, COLUMBUS, GA 31907-3117
(706) 568-5216
(706) 562-1484
Mailing address
4989 POST ROAD PASS, STONE MOUNTAIN, GA 30088-2007
(770) 469-6754
(770) 498-4738
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY000818
GA
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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