Provider Demographics
NPI:1023471703
Name:WILDER, JOSHUA (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:WILDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-415-1450
Practice Address - Street 1:3991 HIGHWAY 78 W STE 201
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3929
Practice Address - Country:US
Practice Address - Phone:678-889-1728
Practice Address - Fax:678-580-0960
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001399213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery