Provider Demographics
NPI:1740276617
Name:ADAMS FAMILY PRACTICE PC
Entity type:Organization
Organization Name:ADAMS FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYNARD
Authorized Official - Middle Name:LEVI
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-264-3434
Mailing Address - Street 1:1323 B MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1545
Mailing Address - Country:US
Mailing Address - Phone:334-264-3434
Mailing Address - Fax:334-834-9071
Practice Address - Street 1:1323 B MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1545
Practice Address - Country:US
Practice Address - Phone:334-264-3434
Practice Address - Fax:334-834-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
510-32779OtherBCBS
32779Medicare ID - Type Unspecified
510-32779OtherBCBS