Healthcare Provider Details

I. General information

NPI: 1225178031
Provider Name (Legal Business Name): MARLA H. WOHLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 MAIN STREET
MILLBROOK AL
36054
US

IV. Provider business mailing address

3351 MAIN STREET PO BOX 589
MILLBROOK AL
36054
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-7808
  • Fax: 334-285-7810
Mailing address:
  • Phone: 334-285-7808
  • Fax: 334-285-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15075
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: