Provider Demographics
NPI:1275773764
Name:JONATHAN WOOLFSON, MD PC
Entity type:Organization
Organization Name:JONATHAN WOOLFSON, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-804-1684
Mailing Address - Street 1:PO BOX 63174
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3174
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:770-516-8768
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7623
Practice Address - Country:US
Practice Address - Phone:678-845-0466
Practice Address - Fax:678-845-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty