Provider Demographics
NPI:1790719318
Name:ADKISON, JARROD B (MD)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:B
Last Name:ADKISON
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:P.O. BOX 5609
Mailing Address - Street 2:SOUTHEAST ALABAMA MEDICAL CENTER, RADIATION ONCOLOGY
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-5609
Mailing Address - Country:US
Mailing Address - Phone:334-793-8081
Mailing Address - Fax:
Practice Address - Street 1:1108 ROSS CLARK CIRCLE
Practice Address - Street 2:SOUTHEAST ALABAMA MEDICAL CENTER, RADIATION ONCOLOGY
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-793-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17602085R0001X
AL29203174400000X
FLME 1064202085R0001X
ALMD.292032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist