Individual
JEFFREY SCOTT WIESEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, FNP
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(678) 207-4373
(770) 533-4727
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN145013
GA
363LF0000X
Family Nurse Practitioner
Primary
APRN-NP145013
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003208071A
—
GA
01
—
06011176
AMERIGROUP
GA
01
—
1692220
WELLCARE
GA
Enumeration date
07/23/2018
Last updated
10/30/2025
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