Provider Demographics
NPI:1720321292
Name:ADAMS, JUSTIN LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LANE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2392
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:1640 BRYAN STATION RD STE 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2144
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-294-7789
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50158207R00000X
KYTP804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100454680Medicaid