Provider Demographics
NPI:1952326951
Name:SILLS, ADAM ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ASHLEY
Last Name:SILLS
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 16788
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6712
Mailing Address - Country:US
Mailing Address - Phone:870-336-1600
Mailing Address - Fax:870-336-0585
Practice Address - Street 1:1003 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6007
Practice Address - Country:US
Practice Address - Phone:870-336-1600
Practice Address - Fax:870-336-0585
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4809207N00000X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5-N562OtherBLUE CROSS & BLUE SHIELD
AR162625001Medicaid
ARI58920Medicare UPIN
AR5N562Medicare PIN