Provider Demographics
NPI:1962859165
Name:ADAMS, WILLIAM LOGAN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOGAN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4928
Mailing Address - Country:US
Mailing Address - Phone:256-629-1000
Mailing Address - Fax:256-629-2709
Practice Address - Street 1:1751 VETERANS DR STE 125
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4932
Practice Address - Country:US
Practice Address - Phone:256-766-0150
Practice Address - Fax:256-764-4638
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.42775208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL275161Medicaid