Individual
GINA D WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 YORKTOWN DR, SUITE 225, FAYETTEVILLE, GA 30214-1568
(770) 460-2331
(770) 460-2099
Mailing address
101 YORKTOWN DR, SUITE 225, FAYETTEVILLE, GA 30214-1568
(770) 460-2331
(770) 460-2099
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO000890
GA
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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