Individual
MARY FOWLER WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1300 OLD WEISGARBER RD, KNOXVILLE, TN 37909-1291
(865) 584-2146
Mailing address
1300 OLD WEISGARBER RD, KNOXVILLE, TN 37909-1291
(865) 584-2146
(865) 374-2103
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3759
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q042877
—
TN
Enumeration date
05/06/2016
Last updated
06/18/2020
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