1770039422 NPI number — WISE WORKS SUPPORT SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770039422 NPI number — WISE WORKS SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISE WORKS SUPPORT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770039422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 PERIMETER CTR E
Provider Second Line Business Mailing Address:
#2432
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-469-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 PERIMETER CTR E
Provider Second Line Business Practice Location Address:
#2432
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30346-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-469-2223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
JERIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
252-469-2223

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)