| Doctor Name: | CHAELI WISENBAKER |
| NPI Number: | 1003229568 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 2412 N Oak St Valdosta, GA - 316022567 |
| Business Phone Number: | 2292441400 |
| Business Fax Number: | 2292445512 |
| Mailing Address: | 3832 Dane Ln, VALDOSTA |
| State: | GA |
| Postal Code: | 31601 |
| Phone Number: | 2297403604 |
| Fax Number: | |
| NPI Enumeration Date: | 06/03/2014 |
| NPI Last Update Date: | 05/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |