Individual
LOIS WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1365A CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-3956
Mailing address
1860 KATHY WHITWORTH DR, BRASELTON, GA 30517-4044
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002947
GA
Other
Enumeration date
09/29/2006
Last updated
07/08/2007
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