Provider Demographics
NPI:1740740778
Name:PURVIS, ADAM T (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:PURVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7283
Mailing Address - Country:US
Mailing Address - Phone:601-477-2014
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:822 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2425
Practice Address - Country:US
Practice Address - Phone:601-477-2014
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine