Healthcare Provider Details

I. General information

NPI: 1962421990
Provider Name (Legal Business Name): GEORGE M. WOLVERTON M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SPRING ST STE 3B
JEFFERSONVILLE IN
47130-3498
US

IV. Provider business mailing address

8009 WEYANOKE CT
PROSPECT KY
40059-9426
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-4309
  • Fax: 812-283-8299
Mailing address:
  • Phone: 502-292-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50000563
License Number StateIN

VIII. Authorized Official

Name: DR. STEVEN MITCHELL JOHNSON
Title or Position: MEDICAL DOCTOR
Credential: D.O.
Phone: 812-282-4309