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Individual
DR. GRAHAM LEONARD WILDE
Active
Individual
DR. GRAHAM LEONARD WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
249
SC
231H00000X
Audiologist
AUD000296
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
249
STATE AUDIOLOGY LICENSE
SC
01
—
AUD000296
STATE AUDIOLOGY LICENSE
GA
05
—
SA0007
—
SC
Enumeration date
11/29/2006
Last updated
07/08/2007
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