Provider Demographics
NPI:1811579055
Name:NICHOLAS V. ADAMS DMD PC
Entity Type:Organization
Organization Name:NICHOLAS V. ADAMS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-724-7300
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-0470
Mailing Address - Country:US
Mailing Address - Phone:229-724-7300
Mailing Address - Fax:
Practice Address - Street 1:400 S WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-3914
Practice Address - Country:US
Practice Address - Phone:229-246-2366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICHOLAS V. ADAMS DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1336219807Medicaid
GA1619593613Medicaid