Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 057862 | GA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 057862 | GA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 057862 | GA |
NPI | 1780668780 |
---|---|
Provider Name | Mark Alan Wolgin |
First Address | Albany, GA 31702-0407 |
Second Address | Albany, GA 31721-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 12/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
525815749A | (05) | GA |
F34718 | (02) | GA |