Provider Demographics
NPI:1457346835
Name:WISNIEWSKI, JOSEPH MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARION
Last Name:WISNIEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12742 HIGHWICK CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-8105
Mailing Address - Country:US
Mailing Address - Phone:865-776-3733
Mailing Address - Fax:
Practice Address - Street 1:1350 MACKEY BRANCH DR
Practice Address - Street 2:STE 114
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3483
Practice Address - Country:US
Practice Address - Phone:423-468-3267
Practice Address - Fax:423-468-3270
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28883207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I112249OtherMEDICARE PTAN
TN103I112249OtherMEDICARE PTAN