JASON EDWARD WILDER

MACON, GA
NPI1922019355
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy247100000X Radiologic Technologist
(Licence:   330869)
Additional Taxonomies2471C3402X Radiologic Technologist, Radiography
(Licence:   330869)
2471M1202X Radiologic Technologist, Magnetic Resonance Imaging
(Licence:   330869)
Enumeration Date2006-08-10
Last Update Date2007-07-08
Business Address
-- JASON EDWARD WILDER R, MR
1504 HARDEMAN AVE SUITE B
MACON, GA 31201-1416
Phone number: 478-745-3135
Mailing Address
-- JASON EDWARD WILDER R, MR
4921 WESLEYAN CIR
MACON, GA 31210-2222
Phone number: 478-477-8969