Provider Demographics
NPI:1124086020
Name:WOLUCHEM, MILTONIA M (MD)
Entity type:Individual
Prefix:
First Name:MILTONIA
Middle Name:M
Last Name:WOLUCHEM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MILTONIA
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1331 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2357
Mailing Address - Country:US
Mailing Address - Phone:770-629-3217
Mailing Address - Fax:404-666-0085
Practice Address - Street 1:1331 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2357
Practice Address - Country:US
Practice Address - Phone:770-629-3217
Practice Address - Fax:404-666-0085
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196867207R00000X
GA76541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY619687-6WOtherWORKERS COMP #
NY051101000018OtherFIDELIS CARE #
NY0414039OtherIHA #
NY9250OtherSIDNEY HILLMAN #
NYMDH910OtherPREFERRED CARE #
NYP010196867OtherBLUE CHOICE #
NY619687-6WOtherWORKERS COMP #
NY051101000018OtherFIDELIS CARE #