Individual
DONNA L WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 OLD HICKORY BLVD STE 410D, JACKSON, TN 38305-2904
(731) 394-2886
Mailing address
106 LANDMARK LOOP, JACKSON, TN 38305-2133
(731) 394-2886
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
1000000038962
TN
Other
Enumeration date
09/25/2025
Last updated
09/25/2025
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