Provider Demographics
NPI:1477585107
Name:ADAMS, TODD JERRY (MD, FACOG, MPH)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JERRY
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD, FACOG, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8545
Mailing Address - Country:US
Mailing Address - Phone:704-658-9211
Mailing Address - Fax:704-658-9224
Practice Address - Street 1:235 MEDICAL PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8545
Practice Address - Country:US
Practice Address - Phone:704-658-9211
Practice Address - Fax:704-658-9224
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200300545207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134KJMedicaid
NC89134KJMedicaid
NC2017941Medicare ID - Type Unspecified