Provider Demographics
NPI:1669749305
Name:DR. JOHN C. ADAMS, JR., PC
Entity type:Organization
Organization Name:DR. JOHN C. ADAMS, JR., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:ED D
Authorized Official - Phone:912-764-6731
Mailing Address - Street 1:102 S ZETTEROWER AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4816
Mailing Address - Country:US
Mailing Address - Phone:912-764-6731
Mailing Address - Fax:912-764-6731
Practice Address - Street 1:102 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4816
Practice Address - Country:US
Practice Address - Phone:912-764-6731
Practice Address - Fax:912-764-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA359251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55361654SAMedicare PIN