Provider Demographics
NPI:1972856995
Name:ADAMS, GWENDOLYN ELEANOR (PA)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ELEANOR
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:GWENDOLYN
Other - Middle Name:ELEANOR
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5750
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-355-9040
Mailing Address - Fax:256-355-9048
Practice Address - Street 1:2422 DANVILLE ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:256-355-9040
Practice Address - Fax:256-355-9048
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA 847363A00000X
ALPA.847363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1063439065OtherMAIN GROUP NPI PAYEE NUMBER
AL011846OtherMAIN GROUP MEDICARE NUMBER
AL630000013Medicaid