Provider Demographics
NPI:1629383922
Name:PROTOS, ADAM NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:NICHOLAS
Last Name:PROTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:504 CLINTON CENTER DRIVE
Mailing Address - Street 2:CBO - SUITE 4300
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5610
Mailing Address - Country:US
Mailing Address - Phone:601-496-9794
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-2005
Practice Address - Fax:601-815-0434
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2021-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA323150208G00000X
MI4301096532208600000X
MS25068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)