Active NPI
Marcie C Wiseman, PHD
- Psychologist
- Valdosta, GA
National Provider Identifier
1225366172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY003561
- Practice address
- 2704 N Oak St
Building B-3
Valdosta, GA 31602-1744 - Phone
- (229) 257-0100
- NPI assigned
- Dec 3, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY003561 | GA | Primary |
Addresses
Primary practice location
2704 N Oak St
Building B-3
Valdosta, GA 31602-1744
Mailing address
2704 N Oak St
Building B-3
Valdosta, GA 31602-1744
Phone (229) 257-0100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003561 | GA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Georgia Psychiatric & Counseling Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Valdosta, GA
- NPI 1477680973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352332800000",
"number": "1225366172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2704 N OAK ST",
"address_2": "BUILDING B-3",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021744",
"telephone_number": "229-257-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2704 N OAK ST",
"address_2": "BUILDING B-3",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021744",
"telephone_number": "229-257-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISEMAN",
"first_name": "MARCIE",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-03",
"last_updated": "2012-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY003561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.