MEDICARE: GENETH KAY WOLFER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	TN DO 000612	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053462168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENETH KAY WOLFER D.O.

Provider Business Mailing Address
First Line	:	1060 GOLDEN MOUNTAIN RD
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1120
Country	:	US
Telephone Number	:	423-802-2249
Fax Number	:	931-284-4470

Provider Business Practice Location Address
First Line	:	1060 GOLDEN MOUNTAIN RD
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1120
Country	:	US
Telephone Number	:	931-933-5743
Fax Number	:	931-933-5743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	01/06/2017

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