Individual
SHAWNTE MICHELE WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
654 MAIN ST, THOMSON, GA 30824-7403
(706) 595-2548
Mailing address
318 TAYLOR POND RD, GRANITEVILLE, SC 29829-3416
(803) 524-3224
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/02/2013
Last updated
07/02/2013
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