Active NPI
Adam Wade
- Occupational Therapist
- Kennesaw, GA
National Provider Identifier
1508358284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 1925 Vaughn Rd NW
Kennesaw, GA 30144 - Phone
- (843) 992-4707
- NPI assigned
- May 30, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | SC | Primary |
Addresses
Primary practice location
1925 Vaughn Rd NW
Kennesaw, GA 30144
Mailing address
1504 Kingdom Way
Indian Land, SC 29707-7757
Phone (843) 992-4707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4341 | SC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528934400000",
"number": "1508358284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1504 KINGDOM WAY",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "297077757",
"telephone_number": "843-992-4707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 VAUGHN RD NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "30144",
"telephone_number": "843-992-4707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "ADAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-30",
"last_updated": "2018-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.