Healthcare Provider Details

I. General information

NPI: 1528098993
Provider Name (Legal Business Name): YOUTHCARE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N HOUSTON RD SUITE 140-H
WARNER ROBINS GA
31093-3074
US

IV. Provider business mailing address

120 OSIGIAN BLVD # B SUITE 100
WARNER ROBINS GA
31088-7880
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-3360
  • Fax: 478-923-9977
Mailing address:
  • Phone: 478-953-5358
  • Fax: 478-953-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number031350
License Number StateGA

VIII. Authorized Official

Name: ROBERT STEPHEN WADE
Title or Position: PHYSICIAN
Credential: MD
Phone: 478-923-3360