Healthcare Provider Details

I. General information

NPI: 1588649693
Provider Name (Legal Business Name): DOUGLAS C. WOLF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD NE SUITE 600
ATLANTA GA
30342-5000
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD STE 600
ATLANTA GA
30342-5020
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-9000
  • Fax: 404-847-9792
Mailing address:
  • Phone: 404-257-9000
  • Fax: 404-847-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number27135
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: