Provider Demographics
NPI:1225755960
Name:DEPEW, ADAM JAMES JOSEPH
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JAMES JOSEPH
Last Name:DEPEW
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 1:1 COLLEGE DRIVE, UWA BOX 4083
Mailing Address - Street 2:104 EAST MAIN STREET
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470
Mailing Address - Country:US
Mailing Address - Phone:256-656-3297
Mailing Address - Fax:
Practice Address - Street 1:UWA STATION 14
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470
Practice Address - Country:US
Practice Address - Phone:256-656-3297
Practice Address - Fax:205-652-3799
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer