Provider Demographics
NPI:1750395570
Name:ADAMS, JOHN ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALEXANDER
Last Name:ADAMS
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:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-1259
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:2689 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-9055
Practice Address - Country:US
Practice Address - Phone:803-438-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP0045738Medicare PIN
SD3819OtherDAKOTACARE
SDF77206Medicare UPIN
SD6001176Medicaid
SD4992861OtherWELLMARK BC/BS OF SD
ND18060Medicaid
SDS101833Medicare PIN