Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD001399 | GA |
Y | 222Z00000X | Podiatrist | POD001399 | GA |
NPI | 1023471703 |
---|---|
Provider Name | Dr. Joshua Wilder |
First Address | Atlanta, GA 30339-3084 |
Second Address | Atlanta, GA 30342-4755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 14/08/2019 |