Individual
DR. EDWARD DALE WYSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
229 ATHENS ST, HARTWELL, GA 30643-1854
(706) 376-3957
(706) 376-1356
Mailing address
229 ATHENS ST, HARTWELL, GA 30643-1854
(706) 376-3957
(706) 376-1356
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015443
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000090703A
—
GA
01
—
024242
BLUE CROSS
GA
01
—
CB5824
RAILROAD MEDICARE
GA
Enumeration date
07/25/2006
Last updated
11/17/2011
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