Individual
MICHAEL JEFFREY WILDENBERG DIAMANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
865 S 1ST ST, JESUP, GA 31545-0210
(912) 427-6811
(706) 660-9390
Mailing address
PO BOX 2585, COLUMBUS, GA 31902-2585
(706) 660-8505
(706) 660-9390
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
034815
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000479025B
—
GA
Enumeration date
11/17/2005
Last updated
01/28/2012
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