Provider Demographics
NPI:1194780338
Name:WOLFE, JAMES ALAN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 MEDICAL CENTER BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7766
Mailing Address - Country:US
Mailing Address - Phone:678-312-3500
Mailing Address - Fax:678-312-3529
Practice Address - Street 1:2200 MEDICAL CENTER BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7766
Practice Address - Country:US
Practice Address - Phone:678-312-3500
Practice Address - Fax:678-312-3529
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36045208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I781435OtherMEDICARE PTAN#
GA000511508CMedicaid