Individual
MRS. LORNA BIPPART WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
120 HIGHGROVE DR, SUWANEE, GA 30024-4294
(770) 889-7414
Mailing address
120 HIGHGROVE DR, SUWANEE, GA 30024-4294
(770) 889-7414
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA001184
GA
Other
Enumeration date
02/11/2008
Last updated
02/11/2008
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