Provider Demographics
NPI:1366682072
Name:JONATHAN WOOLFSON, MD PC
Entity Type:Organization
Organization Name:JONATHAN WOOLFSON, MD PC
Other - Org Name:WOOLFSON EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:7708-041-9684
Mailing Address - Street 1:800 MOUNT VERNON HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4295
Mailing Address - Country:US
Mailing Address - Phone:770-840-1684
Mailing Address - Fax:770-804-1679
Practice Address - Street 1:1980 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5943
Practice Address - Country:US
Practice Address - Phone:770-407-2009
Practice Address - Fax:770-407-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty