Basic Information
| Provider Information | |||||||||
| NPI: | 1831136910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WURL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | LOEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 694 AUTRY RD NE | ||||||||
| Address2: | |||||||||
| City: | ADAIRSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301034425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708773146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 REDMOND RD NW | ||||||||
| Address2: | ANESTHESIOLOGY DEPARTMENT | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 043825 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000749691D | 05 | GA | MEDICAID | P00222658 | 01 | GA | RAILROAD MEDICARE | OTHER | 000749691C | 05 | GA | MEDICAID |