| Wolf Specific, Inc | |
|
1697 Vernon Rd Ste A Lagrange GA 30240-4180 | |
| (706) 415-5245 | |
| Not Available |
| Full Name | Wolf Specific, Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 1697 Vernon Rd Ste A, Lagrange, Georgia |
| Authorized Official Name and Position | Matthew Tyler Wolfertz (PRESIDENT) |
| Authorized Official Contact | 7067565422 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wolf Specific, Inc 1697 Vernon Rd Ste A Lagrange GA 30240-4180 Ph: (706) 415-5245 | Wolf Specific, Inc 1697 Vernon Rd Ste A Lagrange GA 30240-4180 Ph: (706) 415-5245 |
| NPI Number | 1013283563 |
|---|---|
| Provider Enumeration Date | 03/29/2012 |
| Last Update Date | 08/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013283563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | CHIR008690 (Georgia) | Primary |
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