Provider Demographics
NPI:1508196601
Name:JONATHAN WOOLFSON, MD, PC
Entity Type:Organization
Organization Name:JONATHAN WOOLFSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-804-1684
Mailing Address - Street 1:1065 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4953
Mailing Address - Country:US
Mailing Address - Phone:678-284-6314
Mailing Address - Fax:678-284-6282
Practice Address - Street 1:150 INTERSTATE SOUTH DR
Practice Address - Street 2:SUITE 200
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-6211
Practice Address - Country:US
Practice Address - Phone:706-253-2267
Practice Address - Fax:678-454-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty