Organization
WADE FAMILY MEDICINE, LLC.
Active
Other names
Wade Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MODEANNA LEIGH WADE (FNP)
(901) 244-4648
Entity
Organization
Contact information
Practice address
899 HIGHWAY 51 S, COVINGTON, TN 38019-2568
(901) 244-4646
(901) 244-4647
Mailing address
PO BOX 369, MILLINGTON, TN 38083-0369
(901) 244-4648
(901) 244-4647
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
16204
TN
261QR1300X
Rural Health Clinic/Center
16204
TN
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1525986
—
TN
Enumeration date
01/16/2018
Last updated
07/09/2024
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