Most Relevant Information
Provider Data
| NPI Number: | 1003229568 |
| Provider Name: | CHAELI WISENBAKER PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/03/2014 |
| Last Updated: | 05/20/2016 |
Provider Practice Location
2412 N OAK ST
VALDOSTA
GA
316022567
Practice Location Phone/Fax
| Phone: | 2292441400 |
| Fax: | 2292445512 |
Provider Mailing Location
3832 DANE LN
VALDOSTA
GA
31601
Provider Mailing Phone/Fax
| Phone: | 2297403604 |
| Fax: |