MEDICARE: MAX WOLF 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	2085R0202X	Diagnostic Radiology Physician	29972	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	:	1427042498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX WOLF MD

Provider Business Mailing Address
First Line	:	PO BOX 2787
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-2787
Country	:	US
Telephone Number	:	706-653-1102
Fax Number	:	706-653-1230

Provider Business Practice Location Address
First Line	:	616 19TH ST
Second Line	:	DOCTORS HOSPITAL
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1528
Country	:	US
Telephone Number	:	706-494-4282
Fax Number	:	706-494-4459

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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Directions to “ MAX WOLF MD” Practice Location

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