Individual
JASON EDWARD WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R, MR
Contact information
Practice address
1504 HARDEMAN AVE, SUITE B, MACON, GA 31201-1416
(478) 745-3135
(478) 745-3136
Mailing address
4921 WESLEYAN CIR, MACON, GA 31210-2222
(478) 477-8969
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
330869
—
2471C3402X
Radiography Radiologic Technologist
330869
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
330869
—
Other
Enumeration date
08/10/2006
Last updated
09/11/2025
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