Provider Demographics
NPI:1427930478
Name:WISE, MORIAH KIMBERLY (CPM, CLC)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:KIMBERLY
Last Name:WISE
Suffix:
Gender:F
Credentials:CPM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-4110
Mailing Address - Country:US
Mailing Address - Phone:229-261-3404
Mailing Address - Fax:866-831-3234
Practice Address - Street 1:2401 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2331
Practice Address - Country:US
Practice Address - Phone:229-349-4234
Practice Address - Fax:866-831-3234
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife