Provider Demographics
NPI:1548066558
Name:MONICA H WICHNER DO
Entity type:Organization
Organization Name:MONICA H WICHNER DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WICHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-443-2260
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-0862
Mailing Address - Country:US
Mailing Address - Phone:775-443-2260
Mailing Address - Fax:
Practice Address - Street 1:2200 PATRICK HENRY PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4207
Practice Address - Country:US
Practice Address - Phone:775-443-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty