Individual
AUTUM WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 N BROADWAY ST, JOHNSON CITY, TN 37601-3525
(423) 588-9988
Mailing address
102 N BROADWAY ST, JOHNSON CITY, TN 37601-3525
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
000-1410
TN
Other
Enumeration date
04/15/2022
Last updated
04/15/2022
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