Healthcare Provider Details

I. General information

NPI: 1295911683
Provider Name (Legal Business Name): MARLA H WOHLMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 MAIN ST
MILLBROOK AL
36054-3218
US

IV. Provider business mailing address

PO BOX 589
MILLBROOK AL
36054-0012
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: DR. MARLA H WOHLMAN
Title or Position: OWNER
Credential: MD
Phone: 334-285-7808