Provider Demographics
NPI:1629062195
Name:ADAMS, MICHAEL STEPHAN SR (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHAN
Last Name:ADAMS
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:2400 MOUNT ZION PKWY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:770-603-3668
Practice Address - Fax:404-564-6734
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-01-13
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Provider Licenses
StateLicense IDTaxonomies
GA034102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000503566AMedicaid
GA000503566AMedicaid
GA37BBCCFMedicare ID - Type Unspecified