Provider Demographics
NPI:1336219807
Name:ADAMS, NICHOLAS V (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:V
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DMD
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 470
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-0470
Mailing Address - Country:US
Mailing Address - Phone:229-724-7300
Mailing Address - Fax:229-724-7355
Practice Address - Street 1:11079 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-3447
Practice Address - Country:US
Practice Address - Phone:229-724-7300
Practice Address - Fax:229-724-7355
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9183886OtherDORAL USA
GA100913OtherAVESIS