Provider Demographics
NPI:1366975294
Name:ADAMS, ADAM A (NURSING, TECH)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:M
Credentials:NURSING, TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10714 ABERCORN ST
Mailing Address - Street 2:BLDG 34D
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1421
Mailing Address - Country:US
Mailing Address - Phone:443-721-1842
Mailing Address - Fax:
Practice Address - Street 1:10714 ABERCORN ST
Practice Address - Street 2:BLDG 34D
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1421
Practice Address - Country:US
Practice Address - Phone:443-721-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000140026106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician