Basic Information
| Provider Information | |||||||||
| NPI: | 1851362941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLFF | ||||||||
| FirstName: | LUTHER | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7217 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319087217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063226646 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 MANCHESTER EXPY | ||||||||
| Address2: | STE 101A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063222462 | ||||||||
| FaxNumber: | 7063203227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2006 | ||||||||
| LastUpdateDate: | 07/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 055581 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00409805 | 01 | GA | RAILROAD MEDICARE | OTHER | 60049305 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA | OTHER | 52703475-014 | 01 | BLUE CROSS BLUE SHIELD OF GEORGIA | OTHER |