Individual
TERESA GARVIN WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 765-4132
(478) 765-4171
Mailing address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 765-4132
(478) 765-4171
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
RN060359
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
904870559A
—
GA
Enumeration date
07/07/2006
Last updated
11/10/2014
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