Healthcare Provider Details

I. General information

NPI: 1881852622
Provider Name (Legal Business Name): DANIEL WOLENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 SHEFFIELD GLEN WAY NE
ATLANTA GA
30329-3456
US

IV. Provider business mailing address

PO BOX 3491
DECATUR GA
30031-3491
US

V. Phone/Fax

Practice location:
  • Phone: 502-727-6872
  • Fax:
Mailing address:
  • Phone: 502-727-6872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number27263
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: