MEDICARE: MRS. BEATRICE U VON ZESCHAU WILDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	042134	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770634586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEATRICE U VON ZESCHAU WILDER MD

Provider Business Mailing Address
First Line	:	1060 WINDY HILL RD
Second Line	:	SUITE 200
City	:	SMYRNA
State	:	GA
Zip	:	30080-2065
Country	:	US
Telephone Number	:	770-941-7709
Fax Number	:	770-941-6441

Provider Business Practice Location Address
First Line	:	1060 WINDY HILL RD
Second Line	:	SUITE 200
City	:	SMYRNA
State	:	GA
Zip	:	30080-2065
Country	:	US
Telephone Number	:	770-941-7709
Fax Number	:	770-941-6441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/20/2018

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