Provider Demographics
NPI:1285664292
Name:ADAWAY, VICTORIA P (CNS)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:P
Last Name:ADAWAY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531291
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35253-1291
Mailing Address - Country:US
Mailing Address - Phone:205-307-8046
Mailing Address - Fax:205-338-4464
Practice Address - Street 1:1602 COGSWELL AVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1645
Practice Address - Country:US
Practice Address - Phone:205-307-8046
Practice Address - Fax:205-338-4464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-036298364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS70899Medicare UPIN
102I893802Medicare PIN
AL051550272Medicare PIN