Provider Demographics
NPI:1760426563
Name:ADKINS, JERRY ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ROSS
Last Name:ADKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533
Mailing Address - Country:US
Mailing Address - Phone:228-207-4190
Mailing Address - Fax:228-207-4156
Practice Address - Street 1:11516 LAMEY BRIDGE ROAD STE 1
Practice Address - Street 2:
Practice Address - City:D'ILBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39340
Practice Address - Country:US
Practice Address - Phone:228-207-4190
Practice Address - Fax:228-207-4156
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04305208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012155Medicaid
MSB30285Medicare UPIN
MS020000140Medicare ID - Type Unspecified