Healthcare Provider Details

I. General information

NPI: 1689076440
Provider Name (Legal Business Name): JOSEPH ADAMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LYSTER ARMY HEALTH CLINIC 301 ANDREWS AVE.
FORT RUCKER AL
36362
US

IV. Provider business mailing address

200 GATEWAY DR
ENTERPRISE AL
36330-7808
US

V. Phone/Fax

Practice location:
  • Phone: 800-261-7193
  • Fax: 334-255-7710
Mailing address:
  • Phone: 616-719-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number02004727A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number02004727A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: