Individual
MRS. LATOYA LEIGH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 719-7000
Mailing address
P.O. BOX 650865, DALLAS, TX 75265-0865
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
161834
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP134506
TX
Other
Enumeration date
04/23/2012
Last updated
03/03/2025
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