Provider Demographics
NPI:1942800305
Name:VOLFSON, YEVGENY
Entity Type:Individual
Prefix:
First Name:YEVGENY
Middle Name:
Last Name:VOLFSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 MCFALL CT
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-8360
Mailing Address - Country:US
Mailing Address - Phone:678-357-5246
Mailing Address - Fax:
Practice Address - Street 1:1911 EPPS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6130
Practice Address - Country:US
Practice Address - Phone:678-357-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist