Provider Demographics
NPI:1275613465
Name:WOLFE, SAMUEL LAVONE JR
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:LAVONE
Last Name:WOLFE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MERCHANTS WALK SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5267
Mailing Address - Country:US
Mailing Address - Phone:256-880-9788
Mailing Address - Fax:256-880-3228
Practice Address - Street 1:900 MERCHANTS WALK SW
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5267
Practice Address - Country:US
Practice Address - Phone:256-880-9788
Practice Address - Fax:256-880-3228
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL090679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist