Individual
JIM R WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
58 BIG A ROAD, TOCCOA, GA 30577-6017
(706) 886-6819
(706) 282-5368
Mailing address
58 BIG A ROAD, TOCCOA, GA 30577-6017
(706) 886-6819
(706) 282-5368
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22664
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000001834A
—
GA
05
—
000222846A
—
GA
Enumeration date
12/01/2005
Last updated
06/25/2015
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