Healthcare Provider Details

I. General information

NPI: 1760083323
Provider Name (Legal Business Name): CHRISTOPHER WOHLFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BOBBY JONES EXPY
AUGUSTA GA
30907-2433
US

IV. Provider business mailing address

1402 PALMADEO CT
AUGUSTA GA
30907-9283
US

V. Phone/Fax

Practice location:
  • Phone: 479-899-7650
  • Fax:
Mailing address:
  • Phone: 706-836-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022800
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: