Provider Demographics
NPI:1851504989
Name:LEVY, ADAM H (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:H
Last Name:LEVY
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 1:610 3RD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3294
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-738-9739
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3294
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:478-738-9739
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063890207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I100978OtherMEDICARE ID
GA430143645EMedicaid