Organization
ILYA WOLFSON M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILYA WOLFSON M.D. (OWNER)
(770) 591-4777
Entity
Organization
Contact information
Practice address
3380 TRICKUM RD BLDG 1000-102, WOODSTOCK, GA 30188-3690
(770) 591-4777
(770) 406-2340
Mailing address
3380 TRICKUM RD BLDG 1000-102, WOODSTOCK, GA 30188-3690
(770) 591-4777
(770) 406-2340
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
051860
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051415364D
—
GA
Enumeration date
06/30/2009
Last updated
01/23/2025
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