MEDICARE: HEALTHWISE PSYCHIATRY PARTNERS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1487248365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWISE PSYCHIATRY PARTNERS PLLC

Provider Business Mailing Address
First Line	:	1217 ABERNATHY WAY
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-4942
Country	:	US
Telephone Number	:	314-482-2169
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 ABERNATHY WAY
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-4942
Country	:	US
Telephone Number	:	314-482-2169
Fax Number	:

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	DR. OSAMUDIAMEN OSA-EDOH
Credential	:	MD
Telephone Number	:	314-482-2169

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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