Provider Demographics
NPI:1184687378
Name:SOUFLERIS, ADAM JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAMES
Last Name:SOUFLERIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 EAST THIRD STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-4115
Mailing Address - Country:US
Mailing Address - Phone:423-664-5165
Mailing Address - Fax:423-664-5164
Practice Address - Street 1:1000 EAST THIRD STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-4115
Practice Address - Country:US
Practice Address - Phone:423-664-5165
Practice Address - Fax:423-664-5164
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN024399207RI0200X
GA037698207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00608011BMedicaid
TN621726531006OtherCIGNA
TN100011482OtherPHP
1891884292OtherGROUP N P I
TN3074565Medicaid
TN0005746032OtherAETNA
LA1734446OtherLOUISIANA MEDICAID
TN3081725OtherBLUE CROSS
NC5902600OtherNORTH CAROLINA MEDICAID
TN3712427Medicare ID - Type UnspecifiedGROUP MEDICARE
TN621726531006OtherCIGNA
F42447Medicare UPIN