Provider Demographics
NPI:1356322218
Name:ADAMS, JUANAKEE RAEDELL (OD)
Entity Type:Individual
Prefix:DR
First Name:JUANAKEE
Middle Name:RAEDELL
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JUANAKEE
Other - Middle Name:RAEDELL
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1712 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-2023
Mailing Address - Country:US
Mailing Address - Phone:205-323-4608
Mailing Address - Fax:205-252-0203
Practice Address - Street 1:1712 5TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2023
Practice Address - Country:US
Practice Address - Phone:205-323-4608
Practice Address - Fax:205-252-0203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-444-TA-297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000810517Medicaid
AL000810517Medicaid
AL000059682Medicare ID - Type Unspecified