Provider Demographics
NPI:1417075664
Name:ADAMS, JOHN (ARRT, RT (R)(CT))
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:ARRT, RT (R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 GREENVALE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3182
Mailing Address - Country:US
Mailing Address - Phone:502-995-0520
Mailing Address - Fax:502-515-6711
Practice Address - Street 1:4819 GREENVALE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3182
Practice Address - Country:US
Practice Address - Phone:502-995-0520
Practice Address - Fax:502-515-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1003408675247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist