Provider Demographics
NPI:1114967031
Name:COLE, WILFRED Q III (MD)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:Q
Last Name:COLE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:114 TOWNPARK DR NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3715
Mailing Address - Country:US
Mailing Address - Phone:770-952-8612
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:401 SOUTH MAIN ST
Practice Address - Street 2:STE C1
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:770-475-0807
Practice Address - Fax:770-751-8421
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-08-11
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Provider Licenses
StateLicense IDTaxonomies
GA026486207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00292102EMedicaid
GA00292102EMedicaid
A37381Medicare UPIN