Individual
DR. DEENA RENAE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(770) 845-3132
Mailing address
1738 WREN WAY, NICEVILLE, FL 32578-7102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
05305
KY
208000000X
Pediatrics Physician
2002008852
MO
208000000X
Pediatrics Physician
2020-03433
NC
208000000X
Pediatrics Physician
3820
OK
208000000X
Pediatrics Physician
Primary
86763
GA
208000000X
Pediatrics Physician
OS15511
FL
208M00000X
Hospitalist Physician
OS15511
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100877500
—
FL
Enumeration date
01/12/2006
Last updated
04/17/2025
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