Provider Demographics
NPI:1245580414
Name:ADAMS, ANGELA D (NPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 ASHLEE LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4960
Mailing Address - Country:US
Mailing Address - Phone:912-282-9661
Mailing Address - Fax:
Practice Address - Street 1:1706 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5216
Practice Address - Country:US
Practice Address - Phone:912-490-4673
Practice Address - Fax:912-490-4674
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158173174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300027669BMedicaid