Provider Demographics
NPI:1215381991
Name:SPARKS, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 COUNTY ROAD 47
Mailing Address - Street 2:
Mailing Address - City:NEWELL
Mailing Address - State:AL
Mailing Address - Zip Code:36280-2511
Mailing Address - Country:US
Mailing Address - Phone:256-452-1731
Mailing Address - Fax:
Practice Address - Street 1:437 COUNTY ROAD 47
Practice Address - Street 2:
Practice Address - City:NEWELL
Practice Address - State:AL
Practice Address - Zip Code:36280-2511
Practice Address - Country:US
Practice Address - Phone:256-452-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer