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General NPI Number Information
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NPI Number | 1588908453
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Entity Type | Individual
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Provider Name | BEATRICE L WADE-HOLLOWAY CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 705 DIXIE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-3818
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Country | US
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Telephone | 770-812-9666
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 NORTHWINDS PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30009-2280
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Country | US
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Telephone | 770-643-5619
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Fax | 678-352-4322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN180356
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License Number State | GA
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