Provider Demographics
NPI:1114127107
Name:TOCCOA CLINIC MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:TOCCOA CLINIC MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-7537
Mailing Address - Street 1:590 HISTORIC 441 N
Mailing Address - Street 2:SUITE D
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4561
Mailing Address - Country:US
Mailing Address - Phone:706-886-7537
Mailing Address - Fax:
Practice Address - Street 1:590 HISTORIC 441 NORTH
Practice Address - Street 2:SUITE D
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4561
Practice Address - Country:US
Practice Address - Phone:706-886-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0835590003Medicare NSC