Individual
DR. TERRENCE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-5630
Mailing address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-5630
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
056246
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023118620001
—
PA
01
—
2106119
HIGHMARK
—
Enumeration date
02/16/2006
Last updated
03/06/2020
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