Provider Demographics
NPI:1376877274
Name:WADE, AUSPRIA S (PA)
Entity Type:Individual
Prefix:
First Name:AUSPRIA
Middle Name:S
Last Name:WADE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUSPRIA
Other - Middle Name:S
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 SAINT ANDREWS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5120
Mailing Address - Country:US
Mailing Address - Phone:803-386-8684
Mailing Address - Fax:
Practice Address - Street 1:612 SAINT ANDREWS RD STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5120
Practice Address - Country:US
Practice Address - Phone:803-386-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005354363A00000X
SC3458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant