Healthcare Provider Details

I. General information

NPI: 1831552900
Provider Name (Legal Business Name): MATTIE FEASEL WOLF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

1854 BRAEBURN CIR SE
ATLANTA GA
30316-2218
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-6761
  • Fax:
Mailing address:
  • Phone: 252-452-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82907
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number82907
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: