Provider Demographics
NPI:1053462168
Name:WOLFER, GENETH KAY (DO)
Entity Type:Individual
Prefix:
First Name:GENETH
Middle Name:KAY
Last Name:WOLFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GOLDEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1120
Mailing Address - Country:US
Mailing Address - Phone:423-802-2249
Mailing Address - Fax:931-284-4470
Practice Address - Street 1:1060 GOLDEN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1120
Practice Address - Country:US
Practice Address - Phone:931-933-5743
Practice Address - Fax:931-933-5743
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN DO 000612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3301678Medicaid
B04901Medicare UPIN
TN3301678Medicaid