NPI
Lcs Brandon Wilde LLC
Doing business as The Pavilion at Brandon Wilde. NPI 1821580440
Read from the NPPES registry on October 23, 2026.
Facts
- Status
- Active
- Type
- Organization
- Enumeration date
- 2018-05-30
- Last updated
- 2019-06-19
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Specialties
Licenses
- License GA
- 1-036-2130
Location
- Practice location
- 4275 Owens Rd
- City
- Evans GA
- Postal code
- 30809
- Phone
- (706) 868-9800
Organization contact
- Name
- Diane Bridgewater
- Title
- Manager of Managing Member
- Phone
- (515) 875-4500
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. Confirm on OIG's online search.
Nearby
Other NPIs in Evans, GA. 1,211 records in the public file.
Public data from NPPES and CMS. Not a credentialing determination.
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