Organization
WILDWOOD SANITARIUM INCORPORATED
Active
Other names
Wildwood Lifestyle Center and Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY MILLER (DIRECTOR OF PHARMACY)
(706) 419-0023
Entity
Organization
Contact information
Practice address
435 LIFE STYLE LN, WILDWOOD, GA 30757-4174
(706) 419-0023
(706) 820-1474
Mailing address
435 LIFE STYLE LN, WILDWOOD, GA 30757-4174
(706) 419-0023
(706) 820-1474
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009672
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139673
PK
—
Enumeration date
04/05/2013
Last updated
11/27/2013
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