MEDICARE: 2 WOLVES INC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1548884000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2 WOLVES INC

Provider Business Mailing Address
First Line	:	783 S MAIN ST STE 5
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-4519
Country	:	US
Telephone Number	:	912-312-9807
Fax Number	:

Provider Business Practice Location Address
First Line	:	783 S MAIN ST STE 5
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-4519
Country	:	US
Telephone Number	:	912-312-9807
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KIM BOHNE
Credential	:	DNP
Telephone Number	:	912-312-9807

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	06/01/2020

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