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General NPI Number Information
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NPI Number | 1831552900
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Entity Type | Individual
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Provider Name | MATTIE FEASEL WOLF M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 2220 N DRUID HILLS RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3117
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Country | US
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Telephone | 404-785-6761
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Fax |
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Provider Business Mailing Address
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Address Line | 1854 BRAEBURN CIR SE
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City | ATLANTA
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State | GA
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Zip | 30316-2218
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Country | US
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Telephone | 252-452-2760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 82907
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 82907
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License Number State | GA
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