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General NPI Number Information
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NPI Number | 1417747056
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Entity Type | Individual
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Provider Name | WILDNA PHILIPPE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 2701 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5918
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Country | US
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Telephone | 404-501-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 410 MEIJER DR
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City | FLORENCE
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State | KY
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Zip | 41042-5128
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Country | US
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Telephone | 855-791-7201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13104
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License Number State | GA
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