Healthcare Provider Details

I. General information

NPI: 1881678324
Provider Name (Legal Business Name): GREGORY M WOOLFOLK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NICHOLASVILLE RD STE 302
LEXINGTON KY
40503-1457
US

IV. Provider business mailing address

1169 EASTERN PKWY G58
LOUISVILLE KY
40217
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4382
  • Fax:
Mailing address:
  • Phone: 502-452-9567
  • Fax: 502-473-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30826
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: