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1063765642 NPI number — WADE GILREATH

NPI Number: 1063765642
Health Care Provider/Practitioner: WADE GILREATH

Information about “1063765642” NPI (WADE GILREATH) exists in 1063765642 in HTML format HTML  |  1063765642 in plain Text format TXT  |  1063765642 in PDF (Portable Document Format) PDF  |  1063765642 in an XML format XML  formats.

NPI Number : 1063765642 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063765642",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILREATH",
    "FirstName": "WADE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "228 E TENNANT CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICKAMAUGA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30707-1611",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-309-9233",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5380 HIGHWAY 153",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HIXSON",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37343-4946",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-870-8562",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/19/2012",
    "LastUpdateDate": "10/19/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "9837",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "19113",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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