Individual
DR. STEPHEN WILLIAM WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 SUNSET DR, SUITE 501, ATHENS, GA 30606-2293
(706) 208-0065
(706) 459-8693
Mailing address
700 SUNSET DR, SUITE 501, ATHENS, GA 30606-2293
(706) 208-0065
(706) 549-8693
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
033231
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00430372A
—
GA
01
—
279413
BCBS OF GA
GA
Enumeration date
09/08/2005
Last updated
04/10/2008
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