Individual
DEANNA M WILDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
4750 WATERS AVENUE, SUITE 500, SAVANNAH, GA 31404-6261
(912) 352-8346
(912) 355-1414
Mailing address
PO BOX 116336, ATLANTA, GA 30368-6336
(912) 352-8346
(912) 355-1414
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN077963
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003115053A
—
GA
05
—
003115053C
—
GA
05
—
003115053F
—
GA
Enumeration date
09/22/2011
Last updated
09/13/2022
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