Provider Demographics
NPI:1639127285
Name:ADAMS, ATOYA (MD, MBA)
Entity Type:Individual
Prefix:
First Name:ATOYA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E FLAMINGO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5191
Mailing Address - Country:US
Mailing Address - Phone:702-804-5900
Mailing Address - Fax:
Practice Address - Street 1:2110 E FLAMINGO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-804-5900
Practice Address - Fax:702-252-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507235Medicaid
NVI42471Medicare UPIN
NV101402Medicare ID - Type Unspecified