Provider Demographics
NPI:1043405046
Name:WILKIEMEYER, CLAIRE DUDLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:DUDLEY
Last Name:WILKIEMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLAIRE
Other - Middle Name:FRAZER
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:945 RIVER CENTRE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:678-646-0404
Mailing Address - Fax:
Practice Address - Street 1:945 RIVER CENTRE PL
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043
Practice Address - Country:US
Practice Address - Phone:678-646-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055578208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics