Stephen Mark Wilder

Primary specialty

PodiatristTaxonomy code 213E00000X

License

000600 Issued in GA

Practice address

531 7TH Ave
Albany, GA 31701-1921

Phone

(229) 883-3535

Fax

(229) 888-1079

NPI assigned

Aug 24, 2005

Last updated

Dec 21, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261353600000",
    "number": "1750374963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 7TH AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011921",
            "telephone_number": "229-883-3535",
            "fax_number": "229-888-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 7TH AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011921",
            "telephone_number": "229-883-3535",
            "fax_number": "229-888-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "STEPHEN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2009-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "000600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00398956A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tejuanda Shanta Whitehead Sr., MPA,BSW
• Jennifer Whiteley, PA
• Jasmine Shernise Wiggins
• Katrina Michelle Wilburn-Beckhom, M.S.
• Roderick McLeod Wilcox, LCSW, MFT
• Kenna W Wiles, P.A.
• Kadeen Latoya Willacey
• William J. Davanzo, M.D., P.C.
• William Kelvin Lane
• William R. Berry III D.D.S. PC

• Podiatrist in Albany, GA
• Providers in Albany, GA by specialty
• Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.