Provider Demographics
NPI:1861778359
Name:WISE CHOICE THERAPEUTIC SOLUTIONS INCORPORATED
Entity type:Organization
Organization Name:WISE CHOICE THERAPEUTIC SOLUTIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:SHANEKQUA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-436-3397
Mailing Address - Street 1:9 N ZETTEROWER AVE # 9B
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1049
Mailing Address - Country:US
Mailing Address - Phone:912-436-3397
Mailing Address - Fax:912-436-3398
Practice Address - Street 1:9 N ZETTEROWER AVE # 9B
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1049
Practice Address - Country:US
Practice Address - Phone:912-436-3397
Practice Address - Fax:912-436-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies