Provider Demographics
NPI:1740215797
Name:WOLFE, SCOTT JAY (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAY
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19143
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-9143
Mailing Address - Country:US
Mailing Address - Phone:601-445-7773
Mailing Address - Fax:601-445-5911
Practice Address - Street 1:46 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-445-7773
Practice Address - Fax:601-445-5911
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07037821Medicaid
MSG93757Medicare UPIN
MS07037821Medicaid