Healthcare Provider Details

I. General information

NPI: 1013387331
Provider Name (Legal Business Name): SCARLETT ANN WADE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SCARLETT ANN BURGAMY RN

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 5TH AVE
ALBANY GA
31701-1976
US

IV. Provider business mailing address

414 5TH AVE
ALBANY GA
31701-1976
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-4555
  • Fax: 229-888-0063
Mailing address:
  • Phone: 229-883-4555
  • Fax: 229-883-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN204241
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN204241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: