Individual
JERRY PAUL WISDOM III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
1450 ROSS CLARK CIR STE 400, DOTHAN, AL 36301-4770
(334) 305-0400
Mailing address
1450 ROSS CLARK CIR STE 400, DOTHAN, AL 36301-4770
(334) 305-0400
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-152894
AL
Other
Enumeration date
07/20/2021
Last updated
07/20/2021
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