Provider Demographics
NPI:1083608533
Name:ADAMS, CHARLES ATWOOD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ATWOOD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:285 N EL CAMINO REAL
Mailing Address - Street 2:SUITE 219
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5383
Mailing Address - Country:US
Mailing Address - Phone:760-753-9500
Mailing Address - Fax:760-753-0785
Practice Address - Street 1:285 N EL CAMINO REAL
Practice Address - Street 2:SUITE 219
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5383
Practice Address - Country:US
Practice Address - Phone:760-753-9500
Practice Address - Fax:760-753-0785
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG280562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28056OtherMEDICARE PTAN