Provider Demographics
NPI:1083608384
Name:WOOLLEN, THOMAS HAYES (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HAYES
Last Name:WOOLLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7910
Mailing Address - Fax:704-384-7914
Practice Address - Street 1:2801 RANDOLPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1047
Practice Address - Country:US
Practice Address - Phone:704-384-7910
Practice Address - Fax:704-384-7914
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989193Medicaid
NCF90551Medicare UPIN
NC2203786AMedicare ID - Type Unspecified