Organization
GARY A. WISHART, PSY.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY AUSTIN WISHART PSY.D. (OWNER)
(423) 652-2212
Entity
Organization
Contact information
Practice address
601 VOLUNTEER PKWY, SUITE G, BRISTOL, TN 37620-3653
(423) 652-2212
(423) 652-2212
Mailing address
601 VOLUNTEER PKWY, SUITE G, BRISTOL, TN 37620-3653
(423) 652-2212
(423) 652-2212
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P0000001915
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004551019
AETNA
TN
01
—
00610001154
UNITED HEALTHCARE
TN
01
—
0181971
BLUE CROSS/BLUE SHIELD
TN
01
—
085256
ANTHEM OF VIRGINIA
VA
01
—
104229
VALUE OPTIONS
TN
01
—
1982775821
ALL INSURANCE CARRIERS AND MEDICARE
TN
Enumeration date
07/02/2012
Last updated
07/02/2012
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