Provider Demographics
NPI:1972552040
Name:HARRIS, WADE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:ALLEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:ONE INDEPENDENCE POINTE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4566
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4271
Practice Address - Country:US
Practice Address - Phone:864-455-8431
Practice Address - Fax:864-455-8981
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC104172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC104176Medicaid
SCAA41707951Medicare PIN
SCC68899Medicare UPIN
SC104176Medicaid
SCC688994464Medicare PIN