Individual
MISS ALISHA NICHOL WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
529 N GORMAN ST, FORREST CITY, AR 72335-2736
(870) 633-9403
Mailing address
529 N GORMAN ST, FORREST CITY, AR 72335-2736
(870) 633-9403
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
059978
GA
207R00000X
Internal Medicine Physician
Primary
43080
TN
Other
Enumeration date
10/18/2007
Last updated
05/30/2008
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