Individual
GARY AUSTIN WISHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
601 VOLUNTEER PARKWAY, SUITE G, BRISTOL, TN 37620
(423) 652-2212
(423) 652-2212
Mailing address
601 VOLUNTEER PARKWAY, SUITE G, BRISTOL, TN 37620
(423) 652-2212
(423) 652-2212
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001915
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0181971
BCBS OF TN
TN
01
—
085256
ANTHEM BCBS OF VA
VA
01
—
104229
VALUE OPTIONS
TN
01
—
242191000
MAGELLAN
TN
01
—
4098126
BCBS OF TN MEDICAL
TN
01
—
621618739
AARP
TN
Enumeration date
11/13/2006
Last updated
01/26/2012
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