MEDICARE: DR. THOMAS WADE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	83621S	GA

General Provider Information

NPI Number	:	1336219062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WADE M.D.

Provider Business Mailing Address
First Line	:	1800 PHOENIX BLVD
Second Line	:	SUITE 210
City	:	ATLANTA
State	:	GA
Zip	:	30349-5593
Country	:	US
Telephone Number	:	770-994-1360
Fax Number	:	770-994-1264

Provider Business Practice Location Address
First Line	:	1800 PHOENIX BLVD
Second Line	:	SUITE 210
City	:	ATLANTA
State	:	GA
Zip	:	30349-5593
Country	:	US
Telephone Number	:	770-994-1360
Fax Number	:	770-994-1264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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