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General NPI Number Information
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NPI Number | 1184314114
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Entity Type | Organization
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Legal Business Name | WISE CHOICE IV INFUSION CENTER
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 11785 NORTHFALL LN STE 505
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City | ALPHARETTA
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State | GA
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Zip | 30009-7961
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Country | US
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Telephone | 833-294-7348
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Fax | 770-302-0643
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Provider Business Mailing Address
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Address Line | 11785 NORTHFALL LN STE 505
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City | ALPHARETTA
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State | GA
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Zip | 30009-7961
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Country | US
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Telephone | 833-294-7348
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Fax | 770-302-0643
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Authorized Official
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Title or Position | MEDICAL DIRECTOR / MANAGING MEMBER
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Name | DR. THOMAS LOCKE
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Credential | MD
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Telephone | 404-308-8159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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