Provider Demographics
NPI:1255537239
Name:TOLBERT, ETHAN WADE (MD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:WADE
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:404-223-0792
Mailing Address - Fax:404-223-5815
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1185
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-223-0792
Practice Address - Fax:404-223-5815
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-08-18
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Provider Licenses
StateLicense IDTaxonomies
GA46265207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA463493784DMedicaid
GA463493784DMedicaid
GA202I832084Medicare PIN