Provider Demographics
NPI:1851362941
Name:WOLFF, LUTHER H III (MD)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:H
Last Name:WOLFF
Suffix:III
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 7217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7217
Mailing Address - Country:US
Mailing Address - Phone:706-322-6646
Mailing Address - Fax:
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 101A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-2462
Practice Address - Fax:706-320-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055581207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00409805OtherRAILROAD MEDICARE
AL60049305OtherBLUE CROSS BLUE SHIELD OF ALABAMA
52703475-014OtherBLUE CROSS BLUE SHIELD OF GEORGIA
GAP00409805OtherRAILROAD MEDICARE
52703475-014OtherBLUE CROSS BLUE SHIELD OF GEORGIA
AL00942894Medicaid
GA20NCCSVMedicare PIN