| Doctor Name: | LOIS WILDER |
| NPI Number: | 1063504686 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 002947 |
| Business Practice Address: | 1365a Clifton Rd Ne Atlanta, GA - 303221013 |
| Business Phone Number: | 4047783956 |
| Business Fax Number: | |
| Mailing Address: | 1860 Kathy Whitworth Dr, BRASELTON |
| State: | GA |
| Postal Code: | 305174044 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 002947 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |