Provider Demographics
NPI:1033314463
Name:ADAMS, ANNETTE MCPHATTER (ITFS, QPBA)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MCPHATTER
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ITFS, QPBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8774
Mailing Address - Country:US
Mailing Address - Phone:910-875-6370
Mailing Address - Fax:
Practice Address - Street 1:562 SANDERS RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8774
Practice Address - Country:US
Practice Address - Phone:910-875-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator