Organization
ALLIANCE HEALTHCARE SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD GOODMAN WISEMAN FNP (EMPLOYEE)
(662) 252-1599
Entity
Organization
Contact information
Practice address
538 J. M. ASH RD., HOLLY SPRINGS, MS 38635-3238
(662) 252-1599
Mailing address
538 ASH RD., HOLLY SPRINGS, MS 38635-5040
(662) 252-1599
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114188
—
MS
Enumeration date
09/20/2006
Last updated
08/22/2020
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