Provider Demographics
NPI:1568845022
Name:WISEHART, CHRISTINA GIBSON (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:GIBSON
Last Name:WISEHART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SAN DRA WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-8575
Mailing Address - Country:US
Mailing Address - Phone:770-380-8114
Mailing Address - Fax:
Practice Address - Street 1:515 SAN DRA WAY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-8575
Practice Address - Country:US
Practice Address - Phone:770-380-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator