Provider Demographics
NPI:1033319744
Name:WOLFE, GRANT COLLINS (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:COLLINS
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE 412
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1600
Mailing Address - Country:US
Mailing Address - Phone:770-924-9656
Mailing Address - Fax:770-852-7574
Practice Address - Street 1:900 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE 412
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1600
Practice Address - Country:US
Practice Address - Phone:770-924-9656
Practice Address - Fax:770-852-7574
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69738208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery