Healthcare Provider Details

I. General information

NPI: 1538234208
Provider Name (Legal Business Name): JACK H WOLF MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 RIVERBEND RD
GRAHAM NC
27253
US

IV. Provider business mailing address

236 RIVERBEND RD
GRAHAM NC
27253
US

V. Phone/Fax

Practice location:
  • Phone: 336-578-3465
  • Fax: 336-578-3466
Mailing address:
  • Phone: 336-578-3465
  • Fax: 336-578-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK H WOLF
Title or Position: OWNER
Credential: MD
Phone: 336-578-3465