Provider Demographics
NPI:1487673711
Name:ADAMS, GEORGE KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:KENNETH
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 MEADOW LANE COURT
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1469
Mailing Address - Country:US
Mailing Address - Phone:440-282-7411
Mailing Address - Fax:440-282-7419
Practice Address - Street 1:5172 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2162
Practice Address - Country:US
Practice Address - Phone:440-282-7420
Practice Address - Fax:440-282-9855
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001766207Q00000X
OH34.001766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01644567Medicaid
OH0164567Medicaid
OHAD0360463Medicare PIN
OH0360463Medicare PIN