Healthcare Provider Details

I. General information

NPI: 1578875126
Provider Name (Legal Business Name): ANNA WADE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MAIN ST
CARTERSVILLE GA
30120
US

IV. Provider business mailing address

105 W MAIN ST
CARTERSVILLE GA
30120-3507
US

V. Phone/Fax

Practice location:
  • Phone: 770-334-3062
  • Fax: 770-334-8964
Mailing address:
  • Phone: 770-334-3062
  • Fax: 770-334-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3849
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: