Provider Demographics
NPI:1669784344
Name:ADAMS, JESSICA SALEM (DO)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:SALEM
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N 8TH AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2549
Mailing Address - Country:US
Mailing Address - Phone:843-841-3846
Mailing Address - Fax:843-841-3848
Practice Address - Street 1:705 N 8TH AVE STE 2B
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536
Practice Address - Country:US
Practice Address - Phone:843-841-3846
Practice Address - Fax:843-841-3848
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1669784344208600000X
MS30964208600000X
390200000X
SC82967208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1669784344Medicaid