| Ilya Wolfson M.d., Inc | |
|
3380 Trickum Rd Bldg 1000-102 Woodstock GA 30188-3690 | |
| (770) 591-4777 | |
| (770) 406-2340 |
| Full Name | Ilya Wolfson M.d., Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3380 Trickum Rd Bldg 1000-102, Woodstock, Georgia |
| Authorized Official Name and Position | Ilya Wolfson (OWNER) |
| Authorized Official Contact | 7705914777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ilya Wolfson M.d., Inc 3380 Trickum Rd Bldg 1000-102 Woodstock GA 30188-3690 Ph: (770) 591-4777 | Ilya Wolfson M.d., Inc 3380 Trickum Rd Bldg 1000-102 Woodstock GA 30188-3690 Ph: (770) 591-4777 |
| NPI Number | 1275761025 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 03/01/2022 |
| Medicare PECOS PAC ID | 0749331825 |
|---|---|
| Medicare Enrollment ID | O20090701000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275761025 | NPI | - | NPPES |
| 051415364D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 051860 (Georgia) | Primary |
| Provider Name | Ilya Wolfson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942261441 PECOS PAC ID: 5294724324 Enrollment ID: I20040512000351 |
| Provider Name | Maria D Bratoeva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255681243 PECOS PAC ID: 3274778352 Enrollment ID: I20130320000137 |
| Provider Name | Jeff Jean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154848182 PECOS PAC ID: 5193085280 Enrollment ID: I20180209002340 |
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