Provider Demographics
NPI:1477163244
Name:WADE, MITCHELL-LEE (DC)
Entity Type:Individual
Prefix:
First Name:MITCHELL-LEE
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HORIZON HL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5659
Mailing Address - Country:US
Mailing Address - Phone:404-797-0092
Mailing Address - Fax:
Practice Address - Street 1:140 HOWELL RD STE D
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2095
Practice Address - Country:US
Practice Address - Phone:770-740-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor