Provider Demographics
NPI:1770039422
Name:WISE WORKS SUPPORT SERVICES
Entity Type:Organization
Organization Name:WISE WORKS SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-469-2223
Mailing Address - Street 1:70 PERIMETER CTR E
Mailing Address - Street 2:#2432
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346
Mailing Address - Country:US
Mailing Address - Phone:252-469-2223
Mailing Address - Fax:
Practice Address - Street 1:70 PERIMETER CTR E
Practice Address - Street 2:#2432
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1801
Practice Address - Country:US
Practice Address - Phone:252-469-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health