MEDICARE: DR. WILL D. DADE AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AUD003725	GA

General Provider Information

NPI Number	:	1881792869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILL D. DADE AU.D.

Provider Business Mailing Address
First Line	:	PO BOX 51433
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31995-1433
Country	:	US
Telephone Number	:	706-544-3633
Fax Number	:	706-544-4418

Provider Business Practice Location Address
First Line	:	9200 MARNE RD
Second Line	:	RM 77
City	:	COLUMBUS
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	706-544-3633
Fax Number	:	706-544-4418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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