Provider Demographics
NPI:1831136910
Name:WURL, JONATHAN LOEL (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LOEL
Last Name:WURL
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 1:694 AUTRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-4425
Mailing Address - Country:US
Mailing Address - Phone:770-877-3146
Mailing Address - Fax:
Practice Address - Street 1:501 REDMOND RD NW
Practice Address - Street 2:ANESTHESIOLOGY DEPARTMENT
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-291-0291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043825207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000749691DMedicaid
GAP00222658OtherRAILROAD MEDICARE
GA000749691CMedicaid
GA000749691CMedicaid
GA000749691DMedicaid