Provider Demographics
NPI:1730144908
Name:ADAMS, JAMES ELBERT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELBERT
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:183 KEYS FERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3232
Mailing Address - Country:US
Mailing Address - Phone:770-957-6611
Mailing Address - Fax:770-957-1360
Practice Address - Street 1:183 KEYS FERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3232
Practice Address - Country:US
Practice Address - Phone:770-957-6611
Practice Address - Fax:770-957-1360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52150230OtherBCBS GA
GA41ZCFTPMedicare ID - Type Unspecified
GA52150230OtherBCBS GA
GAU17361Medicare UPIN