Provider Demographics
NPI:1225376247
Name:EDMONDS, ADAM (CO, BSME)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:CO, BSME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 W 600 S
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:IN
Mailing Address - Zip Code:46031-9583
Mailing Address - Country:US
Mailing Address - Phone:317-796-8665
Mailing Address - Fax:
Practice Address - Street 1:3170 W 600 S
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:IN
Practice Address - Zip Code:46031-9583
Practice Address - Country:US
Practice Address - Phone:317-796-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker