Provider Demographics
NPI:1225147820
Name:ADAMS, AARON L (RPT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CARNEGIE PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3981
Mailing Address - Country:US
Mailing Address - Phone:770-716-9121
Mailing Address - Fax:770-716-2474
Practice Address - Street 1:155 CARNEGIE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3981
Practice Address - Country:US
Practice Address - Phone:770-716-9121
Practice Address - Fax:770-716-2474
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA036483622AMedicaid
GA036483622AMedicaid