Provider Demographics
NPI:1861416059
Name:WADE, THOMAS A JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:WADE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9247
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9247
Mailing Address - Country:US
Mailing Address - Phone:706-322-7884
Mailing Address - Fax:706-660-2145
Practice Address - Street 1:610 19TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1528
Practice Address - Country:US
Practice Address - Phone:706-322-7884
Practice Address - Fax:706-660-2145
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00144152FMedicaid
GA110054050OtherRAIL ROAD MEDICARE
GA000144152JMedicaid
GA000144152JMedicaid
GA11BDJFJMedicare PIN
GA110054050OtherRAIL ROAD MEDICARE