Provider Demographics
NPI:1598056897
Name:WILES, MARY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY ELIZABETH
Middle Name:
Last Name:WILES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-1000
Mailing Address - Country:US
Mailing Address - Phone:706-745-5541
Mailing Address - Fax:706-745-1361
Practice Address - Street 1:374A PAT HARALSON DR
Practice Address - Street 2:MARY ELIZABETH WILES, DO, PC
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8409
Practice Address - Country:US
Practice Address - Phone:706-745-5541
Practice Address - Fax:706-745-1361
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA71586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20211I3139Medicare PIN