Provider Demographics
NPI:1568420628
Name:ADAMS, JON E (PA)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 COUNTY ROAD 37
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-8127
Mailing Address - Country:US
Mailing Address - Phone:334-670-2122
Mailing Address - Fax:334-670-2103
Practice Address - Street 1:5500 COUNTY ROAD 37
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-8127
Practice Address - Country:US
Practice Address - Phone:334-670-2122
Practice Address - Fax:334-670-2103
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.154363A00000X
ALPA-154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000044791Medicaid
AL051044791OtherBLUE CROSS NUMBER
AL1568420628OtherNPI
AL000044791Medicare PIN
AL051044791OtherBLUE CROSS NUMBER