Individual
DR. JERRY MICHAEL WIETING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
424 N BROAD ST, NEW TAZEWELL, TN 37825-6606
(423) 869-7193
(423) 869-7195
Mailing address
PO BOX 367, HARROGATE, TN 37752-0367
(423) 869-7193
(423) 869-7195
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5101012414
MI
Other
Enumeration date
06/28/2006
Last updated
07/31/2019
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