Provider Demographics
NPI:1629566922
Name:WYATT, JADE ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:ASHLEY
Last Name:WYATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:ASHLEY
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MEDICAL SCHOOL WING E CB# 7039 101 MANNING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7039
Mailing Address - Country:US
Mailing Address - Phone:919-962-2796
Mailing Address - Fax:919-966-2423
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-1125
Practice Address - Country:US
Practice Address - Phone:919-962-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11414337-1205208000000X
NC2021-01448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics