Provider Demographics
NPI:1477587913
Name:ANTHONY-WADE, JANIS N (DO)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:N
Last Name:ANTHONY-WADE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:N
Other - Last Name:ANTHONY-WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D,O
Mailing Address - Street 1:PO BOX 6170
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-1077
Mailing Address - Country:US
Mailing Address - Phone:770-287-8953
Mailing Address - Fax:770-287-8954
Practice Address - Street 1:2766 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-8263
Practice Address - Country:US
Practice Address - Phone:770-287-8953
Practice Address - Fax:770-287-8954
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH48680Medicare UPIN