Provider Demographics
NPI:1528154465
Name:WOOLFSON, JONATHAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:WOOLFSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MOUNT VERNON HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4295
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:770-804-1679
Practice Address - Street 1:800 MOUNT VERNON HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4295
Practice Address - Country:US
Practice Address - Phone:770-804-1684
Practice Address - Fax:770-804-1679
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034529207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000679478GMedicaid
GA000679478HMedicaid
GA000679478IMedicaid
GA000679478JMedicaid
GA000679478DMedicaid
GA000679478EMedicaid
GA000679478FMedicaid
GA000679478BMedicaid
GA000679478CMedicaid
GA000679478EMedicaid
GA000679478GMedicaid