Provider Demographics
NPI:1013387331
Name:WADE, SCARLETT ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:ANN
Last Name:WADE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:ANN
Other - Last Name:BURGAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:414 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1976
Mailing Address - Country:US
Mailing Address - Phone:229-883-4555
Mailing Address - Fax:229-883-4555
Practice Address - Street 1:414 5TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1976
Practice Address - Country:US
Practice Address - Phone:229-883-4555
Practice Address - Fax:229-888-0063
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204241363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN204241OtherGEORGIA NP LICENSE