Provider Demographics
NPI:1659329753
Name:WADE, ROBERT STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:233 N HOUSTON RD
Mailing Address - Street 2:SUITE 140-H
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3074
Mailing Address - Country:US
Mailing Address - Phone:478-923-3360
Mailing Address - Fax:478-923-9977
Practice Address - Street 1:1118 MORNINGSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4948
Practice Address - Country:US
Practice Address - Phone:478-988-2205
Practice Address - Fax:478-988-2201
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA031350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00377836DMedicaid
GA00377836DMedicaid