Provider Demographics
NPI:1588972772
Name:WOLF, ELEANOR (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11377 SOUTHBRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4469
Mailing Address - Country:US
Mailing Address - Phone:404-797-3773
Mailing Address - Fax:770-234-5737
Practice Address - Street 1:11377 SOUTHBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4469
Practice Address - Country:US
Practice Address - Phone:404-797-3773
Practice Address - Fax:770-234-5737
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine