Organization
WISE OMFS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA JACKSON (REVENUE CYCLE MANAGER)
(205) 919-1750
Entity
Organization
Contact information
Practice address
711 KORNEGAY DR, PRATTVILLE, AL 36066-7715
(334) 285-7111
Mailing address
711 KORNEGAY DR, PRATTVILLE, AL 36066-7715
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Enumeration date
05/06/2024
Last updated
05/06/2024
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