Provider Demographics
NPI:1770634586
Name:VON ZESCHAU WILDER, BEATRICE U (MD)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:U
Last Name:VON ZESCHAU WILDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:BEATRICE
Other - Middle Name:U
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1060 WINDY HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2065
Mailing Address - Country:US
Mailing Address - Phone:770-941-7709
Mailing Address - Fax:770-941-6441
Practice Address - Street 1:1060 WINDY HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2065
Practice Address - Country:US
Practice Address - Phone:770-941-7709
Practice Address - Fax:770-941-6441
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042134208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00729286AMedicaid