MEDICARE: JASON EDWARD WILDER R, MR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number
1	247100000X	Radiologic Technologist	330869
2	2471C3402X	Radiography Radiologic Technologist	330869
3	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	330869

General Provider Information

NPI Number	:	1922019355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON EDWARD WILDER R, MR

Provider Business Mailing Address
First Line	:	4921 WESLEYAN CIR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-2222
Country	:	US
Telephone Number	:	478-477-8969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 HARDEMAN AVE
Second Line	:	SUITE B
City	:	MACON
State	:	GA
Zip	:	31201-1416
Country	:	US
Telephone Number	:	478-745-3135
Fax Number	:	478-745-3136

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/11/2025

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