Provider Demographics
NPI:1982702999
Name:MARY BETH WILES, M.D., PC
Entity Type:Organization
Organization Name:MARY BETH WILES, M.D., PC
Other - Org Name:INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-745-5541
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 1:374 PAT HARALSON DR
Practice Address - Street 2:STE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty