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General NPI Number Information
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NPI Number | 1114127107
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Entity Type | Organization
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Legal Business Name | TOCCOA CLINIC MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 590 HISTORIC 441 NORTH SUITE D
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City | DEMOREST
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State | GA
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Zip | 30535-4561
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Country | US
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Telephone | 706-886-7537
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Fax |
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Provider Business Mailing Address
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Address Line | 590 HISTORIC 441 N SUITE D
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City | DEMOREST
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State | GA
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Zip | 30535-4561
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Country | US
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Telephone | 706-886-7537
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JIM R WADE
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Credential |
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Telephone | 706-886-7537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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