Provider Demographics
NPI:1326328303
Name:HUMPHREY, ADAM ISAAC (PA-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ISAAC
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST STE C735
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3310
Mailing Address - Country:US
Mailing Address - Phone:423-778-9101
Mailing Address - Fax:423-778-9190
Practice Address - Street 1:979 E 3RD ST STE C735
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3310
Practice Address - Country:US
Practice Address - Phone:423-778-9101
Practice Address - Fax:423-778-9190
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1992363A00000X
GA363A00000X
TN2177363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant