Individual
JOHNATHAN LLOYD WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
406 N ACADIA RD, THIBODAUX, LA 70301-4856
(985) 446-2890
(985) 446-2189
Mailing address
506 N ACADIA RD, THIBODAUX, LA 70301-4862
(985) 448-1121
(985) 446-8765
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD.308148
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2014
Last updated
04/06/2026
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