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General NPI Number Information
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NPI Number | 1659329753
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Entity Type | Individual
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Provider Name | ROBERT STEPHEN WADE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 1118 MORNINGSIDE DR SUITE A
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City | PERRY
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State | GA
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Zip | 31069-4948
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Country | US
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Telephone | 478-988-2205
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Fax | 478-988-2201
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Provider Business Mailing Address
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Address Line | 233 N HOUSTON RD SUITE 140-H
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3074
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Country | US
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Telephone | 478-923-3360
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Fax | 478-923-9977
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 031350
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License Number State | GA
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