Provider Demographics
NPI:1679020606
Name:WADE, JOHN PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:WADE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 COLISEUM DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3865
Mailing Address - Country:US
Mailing Address - Phone:478-745-6130
Mailing Address - Fax:
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3865
Practice Address - Country:US
Practice Address - Phone:478-745-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0173211835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology