| Doctor Name: | JESSICA WILDER |
| NPI Number: | 1295016780 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 75407 |
| Business Practice Address: | 318 Mall Blvd #300b Savannah, GA - 314064797 |
| Business Phone Number: | 9123581515 |
| Business Fax Number: | |
| Mailing Address: | 318 Mall Blvd, #300b SAVANNAH |
| State: | GA |
| Postal Code: | 314064797 |
| Phone Number: | 9123581515 |
| Fax Number: | |
| NPI Enumeration Date: | 08/29/2011 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 75407 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |