Healthcare Provider Details

I. General information

NPI: 1881737211
Provider Name (Legal Business Name): STEVEN GEOFFREY WISEHART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S ENOTA DR NE
GAINESVILLE GA
30501-2437
US

IV. Provider business mailing address

625 S ENOTA DR NE
GAINESVILLE GA
30501-2437
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-0292
  • Fax: 770-533-7377
Mailing address:
  • Phone: 770-532-0292
  • Fax: 770-533-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number024740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: