Provider Demographics
NPI:1033398169
Name:HEALTHWISE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:HEALTHWISE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-422-1985
Mailing Address - Street 1:140 LACY ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1154
Mailing Address - Country:US
Mailing Address - Phone:770-422-1985
Mailing Address - Fax:770-422-2814
Practice Address - Street 1:140 LACY ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1154
Practice Address - Country:US
Practice Address - Phone:770-422-1985
Practice Address - Fax:770-422-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025749173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C83805Medicare UPIN