1265411672 NPI number — DR. PATRICIA ANNE WOLFE D.O.

Table of content: DR. PATRICIA ANNE WOLFE D.O. (NPI 1265411672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265411672 NPI number — DR. PATRICIA ANNE WOLFE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
PATRICIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIMER
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265411672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1810 MULKEY RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
AUSTELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30106-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-819-9262
Provider Business Mailing Address Fax Number:
678-945-1295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 MULKEY RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30106-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-819-9262
Provider Business Practice Location Address Fax Number:
678-945-1295
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  059238 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H29377 . This is a "HEALTH ASSURANCE INS CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121723 . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018005820002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000120048 . This is a "UNISON HEALTH PLAN OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1769933 . This is a "GREAT WEST HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01114001 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160754 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4500377 . This is a "AETNA INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".




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