Provider Demographics
NPI:1578875126
Name:WADE, ANNA (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3507
Mailing Address - Country:US
Mailing Address - Phone:770-334-3062
Mailing Address - Fax:770-334-8964
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:770-334-3062
Practice Address - Fax:770-334-8964
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3849231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1578875126OtherNPI