Provider Demographics
NPI:1033381769
Name:TARENCE WADE M D P C
Entity Type:Organization
Organization Name:TARENCE WADE M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARENCE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:14435
Authorized Official - Phone:901-282-7815
Mailing Address - Street 1:217 S WASHINGTON AVE
Mailing Address - Street 2:P.O. BOX 5129
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4234
Mailing Address - Country:US
Mailing Address - Phone:662-820-4833
Mailing Address - Fax:662-332-8976
Practice Address - Street 1:217 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4234
Practice Address - Country:US
Practice Address - Phone:662-820-4833
Practice Address - Fax:662-332-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS144352083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty