MEDICARE: SCOTT L ADKISSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS7867	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	748082	OTHER	TN	UNITED CONCORDIA
2	4024874	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1851382444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT L ADKISSON

Provider Business Mailing Address
First Line	:	603 HIGHWAY 321 N
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-5012
Country	:	US
Telephone Number	:	865-986-6566
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 HIGHWAY 321 N
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-6575
Country	:	US
Telephone Number	:	865-986-6566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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Directions to “ SCOTT L ADKISSON ” Practice Location

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