Individual
LISA WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 W MAIN ST, HAMPTON, GA 30228-2187
(770) 507-7772
Mailing address
240 SMITHSTONE PATH, FAYETTEVILLE, GA 30214-5408
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN149678
GA
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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