Provider Demographics
NPI:1184783060
Name:ADAMS, GREGORY SCOTT (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 FLOYD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2529
Mailing Address - Country:US
Mailing Address - Phone:215-519-3535
Mailing Address - Fax:
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-224-1937
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052729OtherMEDICAL LICENSE
MDC0003142OtherMEDICAL LICENSE