Provider Demographics
NPI:1326128083
Name:ADAMS, JIMMY WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:WAYNE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0328
Mailing Address - Country:US
Mailing Address - Phone:304-736-0825
Mailing Address - Fax:304-736-3199
Practice Address - Street 1:6007 US ROUTE 60 E
Practice Address - Street 2:SUITE 304
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1042
Practice Address - Country:US
Practice Address - Phone:304-736-0825
Practice Address - Fax:304-736-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17992081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4016134Medicare PIN
G19214Medicare UPIN