Provider Demographics
NPI:1750381612
Name:ADAMKIEWICZ, THOMAS VINCENT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:VINCENT
Last Name:ADAMKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 MERCER UNIVERSITY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4145
Mailing Address - Country:US
Mailing Address - Phone:770-458-3383
Mailing Address - Fax:770-458-9958
Practice Address - Street 1:3020 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4145
Practice Address - Country:US
Practice Address - Phone:770-458-3383
Practice Address - Fax:770-458-9958
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA408512080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000680875HMedicaid
GA000680875JMedicaid
GA000680875HMedicaid