Individual
DR. GRAHAM LEONARD WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5315B SUNSET BLVD, LEXINGTON, SC 29072-9159
(803) 808-9611
(803) 808-6848
Mailing address
5315B SUNSET BLVD, LEXINGTON, SC 29072-9159
(803) 808-9611
(803) 808-6848
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
249
SC
231H00000X
Audiologist
AUD000296
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
249
STATE AUDIOLOGY LICENSE
SC
01
—
AUD000296
STATE AUDIOLOGY LICENSE
GA
05
—
SA0007
—
SC
Enumeration date
11/29/2006
Last updated
07/08/2007
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