Wollam, Edgar

Wollam, Edgar is an individual health care provider with primary practice located at 1660 Mulkey Rd Ste B, Austell GA 30106. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Wollam, Edgar can be contacted via phone (678) 460-2700.

Contact Information

Primary practice address
1660 Mulkey Rd Ste B Austell GA 30106
Phone: (678) 460-2700
Fax: (770) 739-0212
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 19436 Georgia

Profile Details

NPI number 1316978166
LBN Legal business name Wollam, Edgar
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Oct 19th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316978166 NPPES
Georgia MEDICAID 000146187C
Georgia Other 920632
Georgia MEDICAID 000146187E
Georgia MEDICAID 0001416187H
Georgia MEDICAID 000146187F
Georgia Other 110059639
Georgia MEDICAID 000146187B
Georgia MEDICAID 000146187D
Georgia Other 356860
Georgia Other 581992673003
Georgia MEDICAID 000146187G
Georgia Other 03169

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