Healthcare Provider Details

I. General information

NPI: 1770138885
Provider Name (Legal Business Name): JOSHUA NEIL WISEMAN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 CHATTANOOGA RD
TUNNEL HILL GA
30755-9393
US

IV. Provider business mailing address

3535 CHATTANOOGA RD
TUNNEL HILL GA
30755-9393
US

V. Phone/Fax

Practice location:
  • Phone: 706-673-5211
  • Fax:
Mailing address:
  • Phone: 706-673-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH030483
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: