Individual
MR. PAUL W WICKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-7013
Mailing address
1061 HARMON AVE STE 1D03, SUITE 201, FORT STEWART, GA 31314-5641
(912) 435-7013
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
002062
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97WCGNF
—
GA
Enumeration date
05/16/2006
Last updated
10/07/2010
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