Individual
CHARLES M WISPERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002166
GA
363AS0400X
Surgical Physician Assistant
Primary
002166
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0084PA
—
SC
05
—
682230399A
—
GA
Enumeration date
08/31/2006
Last updated
01/18/2024
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