Provider Demographics
NPI:1255944849
Name:ADAMS, MICHAEL JUSTIN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUSTIN
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 1:821 N MILDRED ST APT 7101
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1662
Mailing Address - Country:US
Mailing Address - Phone:304-261-4072
Mailing Address - Fax:
Practice Address - Street 1:821 N MILDRED ST APT 7101
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1662
Practice Address - Country:US
Practice Address - Phone:304-261-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant