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Organization
PEDIATRIX MEDICAL GROUP
Active
Organization
PEDIATRIX MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA G WILDER RNCNNP (NURSE PRACTITIONER)
(478) 765-4132
Entity
Organization
Contact information
Practice address
777 HEMLOCK ST, BOX 119, MACON, GA 31207-0001
(478) 633-1626
(478) 765-4171
Mailing address
777 HEMLOCK ST, BOX 119, MACON, GA 31207-0001
(478) 633-1626
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
R030659
GA
Other
Enumeration date
04/16/2007
Last updated
08/22/2020
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