Provider Demographics
NPI:1104858034
Name:ADAMS, CHANDRA ALARICE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:ALARICE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHANDRA
Other - Middle Name:ALARICE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6871 BELFORT OAKS PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6242
Mailing Address - Country:US
Mailing Address - Phone:904-674-0022
Mailing Address - Fax:904-425-0192
Practice Address - Street 1:6871 BELFORT OAKS PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6242
Practice Address - Country:US
Practice Address - Phone:904-674-0022
Practice Address - Fax:904-425-0192
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96125207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275841500Medicaid
FLME96125OtherFLORIDA MEDICAL LICENSE