Individual
CORETTA WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
270 CARPENTER DR STE 400, SANDY SPRINGS, GA 30328-4933
(678) 851-5638
Mailing address
270 CARPENTER DR STE 400, SANDY SPRINGS, GA 30328-4933
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051805016
DRIVE LICENSE
FL
Enumeration date
09/19/2017
Last updated
06/16/2018
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