Provider Demographics
NPI:1972571107
Name:WILDSTEIN, ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:WILDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-292-5938
Mailing Address - Fax:404-292-3291
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-292-5938
Practice Address - Fax:404-292-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAD313722086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00178329GMedicaid
GA00178329GMedicaid