Individual
DR. BERNADETTE MARIA MANDES WILDEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
134 ANSLEY DR STE 500, DAHLONEGA, GA 30533-1641
(678) 853-2419
Mailing address
4405 ROSEMAN TRL, CUMMING, GA 30040-9367
(215) 609-7472
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2013-02274
NC
174400000X
Specialist
242668
MA
174400000X
Specialist
70607
GA
174400000X
Specialist
MD.33137
AL
174400000X
Specialist
MD36443
SC
174400000X
Specialist
MD430740
PA
174400000X
Specialist
MD50706
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD430740
PA
Other
Enumeration date
05/22/2007
Last updated
06/20/2014
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