Provider Demographics
NPI:1184314114
Name:WISE CHOICE IV INFUSION CENTER
Entity type:Organization
Organization Name:WISE CHOICE IV INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-308-8159
Mailing Address - Street 1:11785 NORTHFALL LN STE 505
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7961
Mailing Address - Country:US
Mailing Address - Phone:833-294-7348
Mailing Address - Fax:770-302-0643
Practice Address - Street 1:11785 NORTHFALL LN STE 505
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7961
Practice Address - Country:US
Practice Address - Phone:833-294-7348
Practice Address - Fax:770-302-0643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISE IMAGE ENHANCEMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy